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Ten Lectures 



on 



NASAL CATARRH, 



ITS NATURE, CAUSES, PREVENTION, 
AND CURE. 



KELLOGG 




BATTLE CREEK, MICH. : 

Good Health Publishing Company. 

i88q. 



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Go<9D^ 



HEALIH 



FOR 



^1889.e- 



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OR more than TWENTY YEARS GOOD HEALTH has been 

BEFORE THE PUBLIC AS THE LEADING AMERICAN PERIODICAL DEVOTED 
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// is in the most thoroughly practical sense a 

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and practical value. 

A Number of New and Talented "Writers have been Engaged for 
188i>, among whorn are 

DR. FELIX L. OSWALD, 

Leading contributor to the Popular 

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popular magazines. 



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3F»H.XC3DE3, $1.23 A YZES-A-H.- 

jSl. GOOD HEALTH PUBLISHING CO, Battle Creek, Mich. ^ 



TEN LECTURES 



NASAL CATARRH, 



ITS NATURE, CAUSES, PREVENTION, AND CURE, 



aseetses ©f ffje. Y^poetf, -t^y G ) err) a n<zr>, 
le)ue fo .F/ersea (^©rferpp]-), 



WITH A CHAPTER OF CHOICE PRESCRIPTIONS. 




?f 



BY J. H. KELLOGG, M. D. 

member of the British and American Associations for the Advancement of Science, the 
American Public Health Association, the Societe d' Hygiene, of France, the Amer- 
ican Society of Microscopists, the American Medical Association, Etc. : Ed- 
itor of " Good Health;" Author of "Home Hand-Book of Hygie?ie 
and Rational 3fedicine," and various other works. 



2w 



ILLTJSTEiLTED. 



BATTLE CREEK, MICH. : 
GOOD HEALTH PUBLISHING COMPANY, 



I< 



Entered according to Act of Congress, in the year 1889, by 

J. H. KELLOGG, M. D., 

In the Office of the Librarian of Congress, at Washington, D. C. 



PREFACE. 



THIS work consists of the substance of lectures given by" 
the author at various times for the instruction of his pa- 
tients. The purposes of its preparation have been — 

1. To antagonize the popular notion that nasaf catarrh 
is an incurable malady, an error that is productive of vast 
mischief, as it leads to neglect of the disease, entailing 
sufferings which timely attention might easily have pre- 
vented. 

2. To provide in convenient form a manual of the hy- 
giene, of this disease, which is the most essential feature 
of its successful treatment. 

3. To warn the public against catarrh charlatans, and 
the much-vaunted " catarrh remedies" so widely advertized. 
The evils wrought by these " workers of iniquity," are al- 
most beyond estimate. 

4. To present an outline of the modern methods of 
treating this malady, as practiced by scientific specialists, 
and also the results of the author's personal experience 
and observation in the treatment of some thousands of 
cases of this disease. 

It is hoped that this little work will prove of service to 
both physicians and patients. While not undertaking to 
present the technical details of such treatment as can be 
administered only by a specialist, it will furnish the busy 
practitioner a foundation upon which to set his patient at 
work, under his supervision and instruction, with a good 

(iii) 



jv Preface. 

prospect of success in curable cases, ana amelioration in 
even the worst forms. Most of the treatment required in 
ordinary cases of catarrh, can be administered by the pa- 
tient himself, with proper instructions. 

Certain cases, as has been pointed out in the work, re- 
quire the services of the skilled specialist. Competent 
specialists in this line can now be found in nearly every 
' large city. For those who are within reach of such, this 
work is not intended, as no popular treatment of this sort 
can render an unprofessional person thoroughly competent: 
in the management of even a single malady. But to those 
unhappy sufferers who have considered themselves doomed 
to life-long miseries, and to those physicians whose studies 
and experience have not already made them familiar with 
the practical management of nasal catarrh and its accom- 
panying affections, it is hoped this work will prove of real 
value. 

The various instruments, medicaments, etc., required for 
use in the treatment prescribed in this work, may be ob- 
tained from leading druggists, or from the Sanitary Sup- 
ply Co., Battle Creek, Mich. 

J. H. K. 

Battle Creek, Mich., Feb. 20, 



CONTENTS. 



FIRST LECTURE. 
THE NOSE AND ITS USES. 

The Structure of the Nose — The Nasal Mucous Membrane — The Pharyngeal Ton- 
sil — The Nose as a Strainer — The Sense of Smell — Cavities Connected with 
the Nose — The Eustachian Tubes — Natural Breathing — Snoring — Sneezing 
— Nasal Voice 7-19 

SECOND LECTURE. 
ACUTE NASAL CATARRH. 

A Cold in the Head — Sneezing 20-26 

THIRD LECTURE. 
CHRONIC NASAL CATARRH. 

First Stage — Second Stage — Nasal Hypertrophies — Nasal Polypus — Third Stage 27-35 

FOURTH LECTURE. 
PREDISPOSING CAUSES OF NASAL CATARRH. 

'What is a Cold ? — Predisposing Causes of Catarrh — A Gross State of the Body — 

Heredity — Too Much Coddling 36-43 

FIFTH LECTURE. 
EXCITING CAUSES OF NASAL CATARRH. 

Contagious Colds — Imaginary Colds 44-51 

SIXTH LECTURE. 
THE HYGIENE OF NASAL CATARRH. 

The Curability of Nasal Catarrh — Clothing — Diet — Tobacco-Using — Exercise — 

Sleep : '. 52-59 

SEVENTH LECTURE. 
THE TREATMENT OF NASAL CATARRH. 

How to Treat a Common Cold — A Vapor Bath — A Hot-Air Pack — Local Treat- 
ment for a Cold — Inhalants — Snuffs — Solutions — Diet — Hardening — Bath- 
ing — Prevention of Contagion — Hygiene vs. Heredity 60-70 

EIGHTH LECTURE. 

THE LOCAL TREATMENT OF CHRONIC NASAL 
CATARRH. 

How to Cleanse the Nasal Cavity — First Method — Second Method — Third Method 
— Fourth Method — Fifth Method — Sixth Method — Medicated Solutions, 
Vapors, Etc 71-78 

(v) 



vi Contents. 

NINTH LECTURE. 

THE TREATMENT OF SPECIAL FORMS OF NASAL 

CATARRH. 

Simple Chronic Nasal Catarrh — Electricity — Dry Catarrh — Offensive Catarrh — 
Bad Breath — Coryza — Nasal Voice — Mouth-Breathing — Snoring — Cold 
Sores — Nosebleed — Urinary Deposits — Constipation — Headache — Faceache 

— Suffocative Colds — Snuffles — Nasal Polypus — Nasal Obstructions — Ulcer- 
ation of the Septum — Loss of Smell 79~94 

TENTH LECTURE. 

DISEASES OF THE THROAT, EYE, AND EAR, DUE TO 
NASAL CATARRH. 

Acute Tonsilitis — Chronic Inflammation of the Tonsils — Enlarged Tonsils — Acute 
Sore Throat — Diseases of the Larynx — Hoarseness — Catarrhal Cough — 
Chronic Sore Throat — False or Spasmodic Croup — Diphtheria — Hay Fever 

— Disease of the Eye Due to Catarrh — Granular Lids — Diseases of the Ear, 
Resulting from Nasal Catarrh — Earache — Discharge from the Ear 95-H2 

VALUABLE PRESCRIPTIONS FOR NASAL CATARRH. 

Cleansing Solutions — Disinfectant Remedies — Astringent Remedies — Miscellan- 
eous — Remedies to be Applied to the Throat — Eye Lotions — Remedies to be 
Taken Internally for Cough 113-120 



LIST OF ILLUSTRATIONS. 



PAGE. 

Examining the Nose and Throat 9 

Post-Nasal Douche-Tube 75 

Syphon Syringe 75 

The Air Atomizer 76 

The Steam Inhaler 78 

Balsam Bottle 78 

The Eye 106 

The Ear 109 

Pollitzer's Bag for Inflating the Ear 109 

Eustachian Catheter no 

Otoscope no 



COLORED PLATES. 



Plate A. — The Nasal Cavity. 

Plate I. — Posterior Hypertrophy and Enlarged Pharyngeal Tonsil. Same as Preceding, 

Seen from the Pharynx. 
Plate II. — The Larynx, Vocal Cords Open. The Larynx, Vocal Cords Closed. 
Plate III. — Acute Inflammation of the Larynx. Chronic Inflammation of the Larynx. 
Plate IV. — Acute Tonsilitis. Chronic Tonsilitis. 
Plate V. — Acute Pharyngitis. Chronic Pharyngitis. 
Plate VI. — Chronic Pharyngitis, Advanced Stage. Diphtheria. 




PLATE A. — The Nasal Cavity. 



i. The Frontal Sinus ; 2. Sphenoid Cells ; 3 • Cavity communicating 
with the Nose ; 4. Upper Passage ; 5. Middle Passage ; 6. Inner Opening 
of Nasal Duct; 7. Lower Passage ; 8. Cavity in Cheek Bone ; 9. Cavity in 
Opening of Eustachian Tube ; 10. Passage leading from the Nose to the 
Throat: 11. The Uvula. 



NASAL CATARRH: 



ITS NATURE, SYMPTOMS, PREVENTION AND 

CURE. 



FIRST LECTURE. 



®l)e Nose anb Its Hsee. 



Ladies and Gentlemen : It is my purpose to begin 
this morning- a series of lectures on the subject of nasal 
catarrh, — its nature, symptoms, causes, consequences, pre- 
vention, and successful treatment. The increasing preva- 
lence of this disease, the common impression that it is in- 
curable, and the personal experience which many of you 
have had with this malady, assures me that the subject is 
one in which you will be interested. I shall endeavor to 
present this subject, as is my custom in all medical talks 
before an unprofessional audience, in such a way as to make 
it comprehensible, and, so far as possible, interesting, to 
those who are not versed in medical lore, and shall make 
use of no unnecessary technicalities. I hold that the laity 
have a right to as much medical knowledge as they are 
capable of comprehending and can make valuable use of. 
The medical profession is, or at least should be, the most 
thoroughly philanthropic of all professions ; and from my 
stand-point, it is the duty of a physician to diffuse as widely 
as possible such information, which he may gather by study 
and observation, as will be of service to the public in the 
prevention of disease and consequent suffering, and so to 
warn the ignorant respecting their dangers and liabilities, 
as to lead them to pay proper regard to the laws of health. 

Doubtless a vast deal of harm has come by the extensive 
use of various bad nostrums recommended in flaming news- 
paper advertisements for the treatment of nasal catarrh. 
All intelligent physicians condemn these remedies, and yet 
it seems hardly consistent to make a wholesale condem- 

(7) 



8 First Lecture. 

nation of this sort, without offering something better as 
a substitute. To accomplish this is one purpose of these 
lectures. 

Nevertheless, I wish clearly to state at the outset that 
it is no part of my purpose to convey to any one the impres- 
sion that nasal catarrh is a malady so simple that, by means of 
a few written or printed directions, every person can become 
thoroughly competent to treat all cases of the disease suc- 
cessfully. I am certain that any one who carefully follows 
me in the discussion of this subject, will defend me from 
the imputation of any such purpose. It is true, however, 
that a large part of the treatment of nasal catarrh is of 
such character that it may be satisfactorily carried on by 
the patient himself ; and in many cases, especially those 
in which the disease is still in its infancy, the faithful em- 
ployment of such measures of treatment as the patient can 
himself administer with efficiency, may secure, the most sat- 
isfactory results. Indeed, the satisfactory treatment of almost 
all cases of this disease requires that the patient shall him- 
self administer a large part of the treatment, and especially 
that he shall submit to a most careful system of restriction 
as regards clothing, diet, and general regimen, which it is a 
large part of the purpose of these lectures to define. 

Another important purpose of my presentation of this 
subject, is to communicate to you such information concern- 
ing this malady as will give you a just appreciation of its 
gravity, and will impress upon you the importance of con- 
sulting for the relief of its graver forms, not the advertis- 
ing or traveling quack, no matter what his pretensions as 
a specialist, but a well-informed, reliable physician, who has 
given to this subject special attention, in connection with 
a thoroughly scientific medical education. It is certainly 
important that the public should know that chronic nasal 
catarrh involves conditions which often require the most 
careful and skillful surgical attention, and which cannot be 
cured, and in many cases not even temporarily relieved, 
by any other measures whatever. 




Posterior Hypertrophy and Enlarged Pharyngeal Tonsil. 



g 




Same as above, seen from the Pharyi 



The Nose and Its Uses. 



9 



The Structure Of the Nose. — But before we can 
undertake to study this disease understandingly, we must 
become somewhat familiar with the most important feat- 
ures of the structures involved in it. That portion of the 
face which we call the nose, is really the most insignifi- 
cant part of this important organ. To get anything of 
an idea of the nose proper, or of its most essential parts, 
we must take a peep inside. This we are able to do by 
means of a strong light and various instruments, specula, 




EXAMINING THE NOSE AND THROAT. 

mirrors, etc. But as we have not these conveniences at 
hand, we may obtain a fair idea of the territory to be ex- 
amined by means of this chart. (Plate I., Fig. I.) Here we 
have an inside view of the nose, such as would be obtained 
by dividing the head perpendicularly, exactly in the mid- 
dle line of the face. Looking at the cut surface of one-half, 
we first notice a large cavity in the skull, which con- 
tains the brain. In front and beneath this, we see another 
large cavity, nearly divided into two parts by the roof of 
the mouth and the soft palate. The lower portion of this 
cavity, or, as we may now say, the lower cavity, is what 



io First Lecture. 

we are familiar with as the mouth. The upper space is 
known as the nasal cavity, which from its more hidden 
position is less familiar to us. Please observe that it is 
nearly as large as the mouth, and freely communicates with 
the back part of the mouth through a space beneath the 
soft palate, the pendulous continuance of the roof of the 
mouth at its back part. Please notice, also, the consider- 
able extent of the nasal cavity. Also notice that the interior 
surface is largely increased by three scroll-shaped projec- 
tions standing out from either side. They are placed a 
little distance apart, thus forming three horizontal canals 
on each side of the nasal cavity. 

Next, I will call your attention to the fact that the nasal 
cavity is divided in its forward, or anterior, portion by a 
partition, or septum, which can be easily seen and felt 
through the external opening of the nose. This partition ex- 
tends backward about half way to the back side of the nasal 
cavity. It is mostly composed of bone ; but the front por- 
tion is a flexible cartilage, which gives to the end of the 
nose its flexibility, and prevents many serious injuries 
which would otherwise result to this projecting portion of 
the features. 

The back part of the nasal cavity is irregularly dome- 
shaped, its floor being formed by the roof of the mouth and 
the soft palate. Its back wall is continuous with the back of 
the mouth, with which, as before remarked, the cavity of 
the nose freely communicates through. the opening behind 
the uvula and the soft palate. 

4 

The Nasal Mucous Membrane. — Having now 

obtained a pretty good idea of the general form of the 
nasal cavity, let us observe that it is lined throughout 
with a delicate mucous membrane similar to that which 
lines the mouth. In health, this membrane is of a delicate 
pink color, closely resembling the color of the lips. In 
disease, it becomes very greatly changed. 

In health, the mucous membrane is constantly moist. 
This moisture is derived from several sources ; first, from 



The Nose and Its Uses. 1 1 

certain little glands corresponding to the glands of the skin, 
which produce sweat, or perspiration. Some of these pour 
out from the mucous membrane a slightly viscid fluid ; 
others produce a thin, watery, or serous fluid. Another 
source of moistuie is the tears, or lachrymal secretion from 
the eyes, which constantly pour down into the nose through 
the little bony canals which communicate with each eye 
at its inner corner. Lastly, moisture from the expired 
breath is constantly deposited in the nose, which being 
nearer the outside of the body, is of a lower temperature 
than the recesses of the lungs, from which the breath es- 
capes. 

Nature's purpose in supplying the mucous membrane of 
the nose with moisture, is to enable it to moisten the air 
drawn into the lungs through the nose, which is ordina- 
rily drier than the air which escapes from the lungs. If 
no provision of this sort were made, the process of breath- 
ing would remove moisture from the body much too rap- 
idly, and the mucous membrane lining the lungs would be 
dried to such an extent that it could not perform its work 
of purifying the blood from poisonous gases. It is inter- 
esting to note the ingenious economy which nature prac- 
tices in using for this purpose the tears, which have first 
moistened and lubricated the eyeball in its movements be- 
neath the lids ; and further, in throwing out into the cavity 
the numerous shelf-like projections against which the warm, 
moist air from the lungs impinges in its passage outward, 
thus facilitating the condensation of the moisture, so that 
it is again taken up by the incoming air, which is thereby 
moistened, and its contact with the delicate lining mem- 
brane of the lungs, rendered more agreeable. Another wise 
purpose of the numerous scroll-shaped projections along the 
side of the nasal cavity is also apparent, as by this means 
a larger evaporating surface is secured. 

A still further and very useful purpose is also accom- 
plish by the bony projections referred to, in that they pre- 
sent a large surface covered with mucous membrane, which 
is densely crowded with blood-vessels, through which the. 



12 First Lecture. 

warm blood is rapidly coursing ; so that the external air, 
which is ordinarily of a much lower temperature than the 
interior of the body, is warmed in its passage toward the 
lungs. Nature seems also to have wisely calculated the 
proper size for the passages through the nasal cavity, so 
as to properly regulate the tide of air which is constantly 
made to move in and out with the bellows-like action of 
the lungs. 

The Pharyngeal Tonsil. — At the top of the dome- 
shaped back portion of the nose, is found a conspicuous 
collection of glands, by which a considerable quantity of 
secretion is formed. These glands extend down upon the 
back side of the nasal cavity, nearly to a level with the 
roof of the mouth. Everybody is familiar with the fact 
that we have two tonsils in the throat. Tucked away in 
this hidden recess of the head is a third tonsil. The col- 
lection of glands just described is called the pharyngeal 
tonsil. It derives its name from its position. The back 
part of the nasal cavity is sometimes referred to in con- 
nection with the rear portion of the mouth, the two cavi- 
ties together being termed the naso-pharynx. It is impor- 
tant that all should be made acquainted with the pha- 
ryngeal tonsil, for the reason that it is an exceedingly 
troublesome part of one's anatomy, and in a diseased con- 
dition is responsible for a very large share of the incon- 
venience experienced by persons suffering from catarrh. 

The Nose as a Strainer. — A close inspection of 

the external openings of the nose, will reveal the fact that 
just within the outer edge of each opening may be found 
a collection of short hairs, the evident purpose of which 
is to act as a strainer, to prevent dust, insects, and other 
foreign matters which may be suspended or moving in the 
air, from entering the nasal cavity and the lungs. It is 
quite possible, too, that this provision may, to some extent, 
at least, serve a useful purpose in the exclusion of germs. 



The Nose and lis Uses. 13 

The Sense Of Smell. — The mucous membrane cov- 
ering the upper part of the nasal cavity, contains a great 
number of delicate nerve fibers, which pass upward between 
the cells covering the mucous membrane, until their very 
ends are even with the surface. This is probably the only 
place in the body where the nerve fibers are actually un- 
covered. These are the olfactory nerves, or nerves of smell. 
Minute particles of odorous substances entering the nose 
come in contact with these bare nerve ends, and thereby 
give rise to the sensation which we commonly call odor, or 
smell. From this we see that the sense of smell is 
really a delicate sense of touch. That it may be exer- 
cised, it is necessary that the nerve ends should be. kept 
uncovered. If the mucous membrane becomes thickened 
so that the fibers do not reach to the surface, or if it is 
covered over with mucus, it is quite as impossible for the 
nerves of smell to detect odors as for the nerves of touch 
which are found in the fingers to perceive delicate objects 
with the hands encased in a thick covering of leather. It 
is also evident that in order for the sense of smell to be 
exercised, the passages of the nose which lead up to 
the upper part of the nasal cavity, where these nerves 
are located, should be open, so that the air can pass 
in without hindrance, and free from obstructions, as the 
air is the means by which odors are conveyed to the olfac- 
tory nerves. One peculiarity of the nerves of smell, is that 
the impression of an odor which has been received, often 
remains for some time after the odorous substance has 
been removed, a fact the analogue of which is observed in 
the other special senses. 

This function of the nose is not only a source of pleasure, 
in that it enables us to enioy the delightful odors of flowers, 
perfumes, etc., but it is intended by nature to be of the 
greatest use to the body as an active signal against dan- 
ger, by the detection of foul and unpleasant odors, which 
are almost invariably found to be the accompaniments of 
dangerous or poisonous substances. The savage uses his 
nose for the purpose of aiding him in the selection of safe 



14 First Lecture. 

and wholesome food. The sanitarian employs his nose as 
a delicate means of ferreting out unsanitary conditions. 
Unfortunately, this function of the nose is greatly neglected 
among civilized nations. The sense of smell and the odors 
detected by it are little studied. Sounds, and even flavors, 
have been analyzed and classified ; but who has made a 
scientific study of odors ? 

Some lower members of the animal creation are so de- 
pendent upon the olfactory sense, and employ it so con- 
stantly, that it has become developed almost immeasur- 
ably beyond the stage in which we find it in human be- 
ings. For example, the scent of the dog is so keen that 
he can readily track the footsteps of his master hours after 
he has passed along ; and it is said that the members of 
some tribes of savages can distinguish in the dark, and at 
a distance of several feet, those of their own tribe from 
the members of other tribes. Those of you who are familiar 
with the habits of savages, may consider it doubtful whether 
the last fact really affords evidence of any extraordinary 
acuteness of the olfactory sense in savages ; but it is the 
uniform testimony of travelers among barbarous tribes, that 
the sense of smell is with them very much more acute 
than among civilized nations. The fear has been ex- 
pressed, and we apprehend that it is not wholly ground- 
less, that if the sense of smell continues to deteriorate in civ- 
ilized nations in the future as rapidly as in the past, a few 
generations hence races may be found existing in whom this 
sense has become wholly extinct, as has the sense of sight in 
the eyeless fish of the Mammoth Cave. Undoubtedly, na- 
sal catarrh is largely responsible for the decay of this im- 
portant sense. 

The sense of smell is closely associated with the sense 
of taste ; that is, many things which we think we taste, 
we really smell ; and perhaps in some instances the reverse 
may be true. For example, the onion, the potato, and most 
other vegetables, have little or no real taste, but have char- 
acteristic odors, which during the chewing of the food find 
their way from the mouth through the passage behind the 



TJic Nose and Its Uses. 15 

soft paiate, and into the nasal cavity, and thus come in con- 
tact with the nerves of smell. One can easily demonstrate 
this fact by tightly closing the nostrils when eating any of 
the foods mentioned. In so doing, it will be found that 
the article seems to be almost devoid of flavor. 

The nose is very liberally supplied with blood-vessels, 
which are closely connected, through their branches, with 
the blood supply of the mouth, ears, eyes, and front part 
of the brain. This membrane is also richly supplied not 
only with nerves of ordinary sensation, but with branches 
from the sympathetic nerve, by which it is very closely 
related with the upper part of the spinal cord, and through 
it with every part of the system, particularly with the stom- 
ach, liver, lungs, face, scalp, chest, and neck. This con- 
nection of the nose with other parts, through the sympa- 
thetic system, is a fact which is very important for us to 
remember, as it is through these intimate nerve relations 
that the numerous and varied symptoms attending nasal 
catarrh in its several stages, arise. 

Cavities Connected with, the Nose. — "Rooms 

to let" is an expression we sometimes hear used respect- 
ing a person who is supposed to have a*deficiency of in- 
tellect, notwithstanding a large development of the head. 
Doubtless those who make use of this expression are quite 
unaware of the fact that every person has a number of 
vacant rooms in his head. There are at least eight such 
chambers in different parts of the skull, which communi- 
cate with the nasal cavity. Two of the largest of these 
— the so-called frontal sinuses — are found in the skull just 
above and between the eyes. Two others are found in the 
face bones, one on either side. Still others are found in 
the bones which help to form the sides and back of the 
nasal cavity. These cavities are connected with the nasal 
cavity by means of small openings or canals. In addition, 
the nasal cavity is connected with each eye by a bony 
canal, as previously mentioned, and a canal also extends 
from the sides of the back portion of the nasal cavity to 



1 6 First Lecture. 

each ear. The position of most of these various parts can 
be easily seen by reference to Plate I. The purpose of 
all these cavities it is not easy to explain, although the use 
of some of them is very apparent. They add sonorousness 
to the voice, and diminish the weight of the bones. 

As already explained, the nasal ducts which connect the 
eyes and the nasal cavity, act as sewers to drain off the 
tears. Ordinarily, these canals are sufficient to carry away 
the watery secretion of the eyes ; but when the tears 
are secreted very abundantly, as in weeping, a large por- 
tion escapes over the lids, and runs down the cheeks. 

The Eustachian Tubes.— The canals which connect 
the nasal cavity with the ears, are exceedingly useful to the 
latter organ. They not only allow secretion from the middle 
portion, or drum, of the ear to escape into the nose, but 
provide for an interchange of air between the ear and na- 
sal cavity, by which the pressure within the ear is kept 
uniform with the external pressure. To facilitate this pro- 
cess, which might be termed " ear-breathing," the openings 
at the nasal ends of the ducts leading from the ears, which 
are known as the "Eustachian canals," are placed just oppo- 
site the inner extremity of the lowermost passage from 
the nose, and on a level with it. In ordinary breathing, 
almost the entire amount of air which passes through the 
lungs goes through these lower canals, so that the air-cur- 
rents strike directly upon the mouths of the Eustachian 
tubes, by which the entrance of the air to the ears is greatly 
aided. When the air is drawn into the nose with a forcible 
effort, as in snuffing, the air-current strikes the upper 
part of the nasal cavity. This is why we involuntarily 
sniff the air when we wish to sharpen the sense of smell. 

Natural Breathing. — From what has been already 
said, it must be apparent that the nose is the only proper 
channel for breathing, under ordinary circumstances. It 
will be remembered that in connection with breathing, the 
nose renders valuable service in several particulars. It not 



The Nose and Its Uses. \J 

only moistens the air, but modifies its temperature, raising 
or lowering the temperature of the inspired air, according 
as the external temperature may be lower or higher than 
that of the body. It acts as a filter in excluding extrane- 
ous matters ; it is a sanitary detective, through its ability to> 
recognize bad odors ; it regulates the rate of the air-supply 
by the precisely proportioned size of its channels, and, 
incidentally, by the direction given the air-currents, aids in. 
changing the air in the cavities of the ears. When breath- 
ing is performed through the mouth, all of these various; 
useful offices are neglected, and numerous evil consequences 
arise, not only to the nose and ears, but to the throat and 
the lungs and other portions of the body, as will be pointed 
out at another time. 

A curious fact which illustrates the intimate relations 
between the nose and the lungs, may be made apparent by 
a simple experiment. Close one nostril, then take a deep 
breath. It will be observed that the two sides of the chest 
do not expand equally. The side corresponding with the 
unobstructed nostril will expand freely, while the other will 
not. This is doubtless due to the stimulus imparted to 
the nerves of the nasal mucous membrane by the impact 
of the air-current forcibly drawn in. The reflex relation 
of the nose and the muscles of respiration, causes the more 
vigorous action of the unobstructed side. .It thus appears 
that unobstructed breathing is a matter of vital import- 
ance, and not only to the lungs, but to the whole body. 

Snoring. — Breathing is naturally performed without 
sound. Audible breathing is always unnatural and un- 
healthful. It is usually occasioned by partial or complete 
obstruction of the nose. Snoring is exaggerated audible 
breathing in which air is inhaled through both the nose 
and the mouth at the same time. A peculiar sound is 
produced by the rythmical vibration of the pendulous por- 
tion of the soft palate, the membrane which hangs loosely 
at the back of the throat, which is thrown into strong- 
vibrations by the action of the two currents of air, one 



a 8 First Lecture. 

entering through the partially-obstructed nose, the other 
through the mouth, and meeting at the back part of the 
throat. Obstruction of one nostril may not be sufficient 
to produce snoring, provided there is a large opening 
through the other nostril ; but whenever the obstruction 
of the nose becomes so great as to render nose-breathing 
difficult, the mouth falls open as soon as the individual 
"becomes unconscious in sleep, and snoring, which often 
renders night hideous to persons of sensitive ears, at once 
begins. A full consideration of the causes and cure of 
snoring and mouth-breathing, must be left for another occa- 
sion. 

Sneezing is a modification of breathing in which the 
nose is chiefly concerned, although it takes no active part. 
It is produced by a sudden contraction of the expiratory 
muscles, forcing the air out at both the nose and the 
mouth. The act of sneezing is usually excited by an ir- 
ritation of the mucous lining of the nose. When one 
sneezes in connection with taking cold, it is due to con- 
gestion of the lining membrane of the nose, and is the result 
of an effort of nature to counteract the injurious effects of the 
chill by producing a reaction. Sometimes sneezing results 
from looking at a bright object. This is due to the sym- 
pathy between the nose and the nerves of sight. The 
same sympathy is exhibited in the profuse flow of tears 
which usually accompanies a fit of sneezing. 

Nasal Voice. — A few words respecting the relation 
of the nose to the voice : Every one who has ever had a 
severe "cold in the head," will remember an embarrassment 
in speaking words containing certain sounds, when the nose 
-was obstructed. The sounds of n and m are either not artic- 
ulated at all, or are converted into the sounds of d and b. 
For instance, the word pudding is spoken as though spelled 
.without an n, and dumb is pronounced dub. We usually 
;say that a person speaking thus has a nasal tone, or that 
he speaks through his nose; this is quite incorrect, for in 
Tact he is trying to talk without his nose, which is an 



The Nose and Its ( T ses. 19 

unnatural and awkward proceeding. The nose seems to 
be indeed a Sort of resonating chamber for the voice ; and 
when the nostrils are obstructed, even to a small extent, 
the voice is materially and unpleasantly modified. This is 
a consideration which every person who is suffering from 
catarrh, even to a limited extent, should seriously bear in 
mind ; and such should also be informed that these harm- 
ful modifications of the voice often become so grave in 
character and extent that even the highest degree of 
medical skill can afford only partial relief. 

In conclusion, for the present occasion, I wish only to 
remark that I have given no description of the throat, or 
pharynx, first, because our chief business is to study the 
nose and its diseases ; and second, because by standing 
before a mirror, and pressing down the tongue with a spoon, 
each of you, without the aid of a teacher, may become 
quite familiar with the construction of the throat. I may 
merely mention that the pendulous membrane at the back 
of the throat is called the soft palate, the central and more 
dependent portion being termed the uvula, and that the 
two small lumps on either side, placed between the two 
loose folds of membrane termed the fauces, are the ton^ 
sils, of which we shall have occasion to speak more fully 
at another time. 



SECOND LECTURE 



^cutc Nasal Catarrl). 



"A COLD IN THE HEAD. 

THE literal meaning - of the word catarrh is a " flow," 
or " discharge." The term is applied to the disease which 
we are considering, on account of the prominence, as a 
symptom, of the discharges peculiar to this malady ; but 
it is important that we should at once divest our minds 
of the common notion that catarrh of the nose is neces- 
sarily accompanied by a profuse discharge. We frequently 
find persons suffering seriously from chronic catarrh, who 
have been so little inconvenienced by nasal discharges 
that they have never suspected the presence of the dis- 
ease until other of its more serious results have begun to 
make their appearance. An excess of secretion is present 
in some form in most cases of this disease, at least in its 
earlier stages ; but this symptom is by no means the 
most serious or the most constant of the various unpleas- 
ant features of this disease. 

Before we undertake to define more exactly the nature 
of the disease which we are considering, let us recall some 
of the chief facts which we have learned respecting the 
nasal cavity and its surroundings : — 

1. We have learned that the nasal cavity is an irregu- 
larly shaped space which is divided into two nearly equal 
parts by the septum of the nose. 

2. The outer walls of the cavity present a number of 
deep furrows, which are formed by projecting ridges of 
the bone, which jut out toward the septum. 

3. The nasal cavity communicates with the mouth by 
a large opening behind the soft palate, the latter acting 
as a sort of valve by means of which the opening be- 
tween the nose and the mouth may be controlled. 

(20) 



Acute Nasal Catarrh. 21 

4. The nasal cavity is also connected with the drum 
of each ear by a duct on either side, which allows the 
air from the nasal cavity to enter the ear. 

5. The nasal cavity is connected with a number of 
other similar cavities, the chief of which are two quite 
large cavities in the bones of the face, the cavity called 
the frontal sinus, found in the skull just between the eyes 
and on a level with the eyebrows, and several large cells 
in the base of the skull. 

.6. The nasal cavity is lined with a delicate pink tissue 
called mucous membrane. This same covering extends 
through the small ducts connecting the nasal cavity with 
other cavities, and also lines these cavities. The ducts 
extending to the eye and the ear are also lined with mu- 
cous membrane, as is also the drum of the ear. 

7. In the upper part of the nasal cavity the mucous 
membrane contains very delicate nerve fibers, in which 
resides the olfactory sense. 

In order that we may understand the nature of this 
delicate membrane which lines the nasal cavity, let us 
compare it with the skin, a structure with which we are 
more familiar. If we place a small portion of the skin 
under a magnifying glass of moderate power, the first 
thing we shall notice is that we are scaly creatures. The 
scales which cover our bodies are not like the great horny 
plates which constitute the covering of most fishes and 
some species of reptiles, but are so minute and delicate 
that a magnifying glass is required to render them visi- 
ble. We may at any time collect a few for examination, 
by gently scraping the surface of the skin with the edge 
of a knife. These scales we are constantly shedding, they 
being rubbed off by the friction of clothing, and by various 
objects with which we come in contact. When one takes 
a Turkish bath, these skin scales are sometimes rubbed 
off by the shampooer in astonishing quantities. If we 
study the skin more closely, we find in it two sets of se- 
cretory organs, or glands. One set produces the watery 
fluid called perspiration, or sweat; the other produces a 



22 Second Lecture. 

thicker, fatty, or oily, matter, by which the surface of the 
skin is lubricated. The skin also contains numerous 
nerves, in which reside the senses of touch and tempera- 
ture. 

The mucous membrane is a sort of inner skin, or, as 
has been termed, a lining skin, and very much resembles 
in structure, though less in appearance, the outer cover- 
ing of the body. The mucous membrane, like the skin, 
is covered with scales. These do not, however, dry up 
and fall away, as in the case of the skin, but are washed 
away by the fluid which is always found moistening the 
surface of a healthy mucous membrane. If you will place 
under a microscope a drop of saliva from the mouth or 
of clear mucus from the nose, you will find in it a great 
abundance of these scales. The mucous membrane, like 
the skin, contains glands also. As in the case of the skin,, 
one class of these glands produce a thin watery fluid, 
much like the serum of the blood, from which they are 
called serous glands. The other set of glands produce a 
thicker and somewhat tenacious . fluid, termed mucus, 
which is quite unlike the oily secretion of the skin. You 
see, then, that the fluid formed by the mucous membrane 
is made up of three things, — the watery fluid formed by 
the serous glands, the mucus formed by the mucous 
glands, and the scales which are shed by the mucous mem- 
brane. In catarrh accompanied by a discharge, there is 
always an increase in some of these elements. If the dis- 
charge is watery, it is because there is an increase of the 
serous fluid. If it is thick, it is because there is a great 
increase in the amount of mucus formed, and in the quan- 
tity of mucous scales thrown off. 

Catarrh is not confined to the nasal cavity. It may af- 
fect the membrane lining the eye-lids and covering the 
eye-ball, that which lines the ears, the lining membrane of 
the cavities adjacent to the nasal cavity, the mouth, the 
air passages, the stomach, the intestines, the bladder, or, 
indeed, any portion of the body which is covered or lined 
by mucous membrane. From the similarity between the 



Acute Nasal Catarrh. f$ 

skin and the mucous membrane, it may occur to you that 
these two structures might easily be affected by the same 
disease ; and this is exactly true. When a child has 
scarlet fever, the eruption upon the skin is accompanied 
by a similar eruption upon the mucous membrane. It is 
this which produces the strawberry tongue and the sore 
throat which accompany these diseases. The nasal and 
throat symptoms which accompany measles are another 
illustration of the same fact. The same is also true of 
catarrh. The skin, as well as the mucous membrane, may 
be affected by a disease essentially the same as catarrhs 
A common disease of this character is ordinarily known 
as eczema, salt rheum, or moist tetter. 

A " Cold in the Head."— We are now prepared to 
enter a little more deeply into our subject. Let us study- 
first the symptoms by which we may know when this 
disease is present. The simplest form of nasal catarrh is 
that common affection ordinarily termed •' a cold in the 
head." The symptoms present in this condition must be 
familiar to most of you from personal experience ; but in 
order that we may understand the relation of this simple 
form of disease to its more serious and chronic phases, it 
is well that we should study them somewhat closely. 

In order to illustrate the subject for you, I have asked 
a gentleman who has just consulted me for the relief of 
an acute cold, to present himself before you as a clinical 
subject, and allow us to question him. W T hile I have been 
talking, you have noticed that he has sneezed several 
times. He is obliged to use his handkerchief almost con- 
stantly, on account of a watery discharge from the nose. 
You observe that his eyes are red. As I open his nostrils 
by means of a little instrument called a nasal speculum, 
I see that the lining of his nose presents a red appearance, 
like his eyes. We say that his eyes are "blood-shot," 
which means that the blood-vessels are so distended with 
blood that they are visible. The mucous membrane 
lining the nose is also blood-shot, or congested ; and as 



24 Second Lecture. 

the patient opens his mouth and allows me to hold down 
his tongue with a tongue depressor, I look in, and find that 
his throat presents the same red and congested appearance. 
You observe also that his face is flushed. There is too 
much blood in his head. He says that his head aches ; 
and as I take his hand to feel his pulse, I notice that the 
skin is hot and dry. He says he feels feverish, and is 
obliged to drink very often. I count his pulse, and find 
that it indicates a slight fever ; and if we place a ther- 
mometer in his mouth, we shall find that his temperature 
is one or two degrees above the normal, or healthy, stand- 
ard. Very likely it is about ioo° F. 

If you observed his tongue when we were looking into 
his throat, you noticed that it was covered with a white 
coat. The patient says he has a bad taste in his mouth, 
and has no appetite. His bowels are inactive. The se- 
cretion of the kidneys is disturbed, as is indicated by a 
pink, whitish, or brick-dust sediment. The patient says 
that his " bones ache," that his flesh is sore, that he feels 
weak and unable to perform his usual duties. He feels 
dull and stupid. Now and then he has shivering sensa- 
tions along the spine. 

If we ask our patient when he contracted this cold, he 
■will tell us that he has not been feeling quite so well as 
usual for a day or two ; that he was a little bilious ; ap- 
petite not quite so good as usual, and bowels inactive ; 
but that he thought little of his condition until two or 
three hours ago, when, as he was sitting at work in a 
room without a fire, he began to sneeze ; and knowing at 
once that he was taking cold, he removed to a warmer 
room, but has been sneezing at short intervals ever since, 
and his cold seems to be getting worse every moment. 

Sneezing. — Our friend thought, and this is the com- 
mon notion, that the sneezing was a sign that he was 
taking cold. This is quite a mistake. Sneezing is an evi- 
dence that a cold has already been taken. When a per- 
son begins to sneeze, he already has a cold, and the 



Acute Nasal Catarrh. 25 

sneezing is nature's atcempt to cure it. This idea probably 
strikes you as a curious one, yet I believe it to be true, 
nevertheless. When one makes a vigorous sneeze, the 
action is not of the nose, but of almost the entire body. 
In other words, he sneezes all over ; almost every muscle 
of the body makes a jerk. Our unfortunate friend is just 
now getting ready for an explosion. Notice how strangely 
the muscles of his face twist his countenance out of shape. 
He is taking a deep breath. Nature is getting ready to 
fire a powerful blast at the enemy which is invading her 
domain in the shape of a cold. There it goes, " ker- 
chew ! " It nearly lifted him off his chair. Every mus- 
cle in his body made a jump. A sneeze is a spasm by 
which nature undertakes to re-establish the equilibrium of 
the nervous forces and the circulation, which have been 
disturbed by a cold draught or some other cold-producing 
influence to which the individual has been exposed. I 
have really sometimes seriously considered whether it 
would not be a proper thing to revive some of the old- 
fashioned sternutatories of the pharmacopoeias of two cent- 
uries ago, as remedies to be used in the first stage of a 
cold. At any rate, I imagine that a few pinches of snuff 
at this particular period, provided nature is not able to 
get up a sufficient number of vigorous sneezes, might be 
beneficial ; only I should insist that it be not " Scotch 
snuff," or any other narcotic mixture. 

We have already noticed that the discharge at this 
stage of a cold is of a watery character. In the course of 
a few hours, the discharge will become somewhat thicker 
and opaque. If the patient has not previously suffered 
from repeated attacks of cold, the discharge will gradually 
lessen, and the various other symptoms will disappear ; 
and in the course of a week, he will feel as well as 
usual, provided he takes ordinary care of himself; and 
that without any special treatment, either general or local. 
His cold will have been cured by the natural recuperative 
efforts of the system. If, however, through exposure, our 
patient gets an addition to his cold before he has fully 



26 Second Lecture. 

recovered, or if his system at the time the cold was con- 
tracted was in a state of preparation for catarrh, a condi- 
tion in which the liver, skin, and other organs of excre- 
tion were inactive, so that the blood and tissues were 
filled with effete or impure matters which should have 
been eliminated, then the cold will not terminate so 
quickly. Instead, several weeks or months may elapse be- 
fore nature is able to complete the remedial process, or, 
in other words, the disease may become chronic. It may, 
indeed, become so thoroughly seated that nature will break 
down in her attempt to restore the patient to health, and 
a permanently diseased condition will be established. 



THIRD LECTURE. 



Chronic Nasal (Eatarrl), 



CHRONIC catarrh of the nasal cavity and adjacent parts; 
may be divided into three stages, which are sometimes 
considered as distinct diseases, but are really different de- 
grees of development of the same disease. 

First Stage. — The first stage of chronic nasal catarrh 
is simply a continuation of the acute disease. Instead of 
getting well, the patient continues to be troubled with a 
profuse thick discharge from the nasal cavity, which 
obliges him to use a handkerchief frequently, and often 
annoys him by frequent droppings or accumulations in the 
throat. In some cases, the disease is confined almost: 
wholly to the front part of the nasal cavity, while in 
others, it is chiefly located in the back, post-nasal, or 
naso-pharyngeal region. At first, the discharge is of a 
whitish color ; but after a time, it becomes greenish. The 
discharge is variable in quantity, sometimes disappearing 
entirely ; at other times, especially when aggravated by a 
cold, becoming exceedingly profuse. Indeed, the amount of 
mucus sometimes discharged by the nasal cavity in twen- 
ty-four hours, is quite astonishing. Frequently the amount: 
is so great as to seriously disturb the breathing, especially 
during sleep, and to give the voice a nasal tone, by ob- 
structing the nasal passages. The patient finds, however, 
that this inconvenience may be relieved by vigorous blow- 
ing of the nose, and frequently resorts to this method of 
ridding himself of the obstruction. In many cases, this 
violent blowing of the nose is found to produce serious 
inconvenience, as distress across the forehead, faceache, a 
stuffed-up feeling in the ears, and earache. These symp- 
toms are due to the fact that in violent blowing of the 
nose, the air is forcibly driven into the various cavities of" 

(27) 



28 Third Lecture. 

the nose, which have been previously described. The ex- 
tra strain to which these cavities, and also the delicate 
structures of the ear, are subjected, produces the unpleas- 
ant symptoms mentioned ; and it is possible, indeed, that 
through violent blowing of the nose, portions of mucus 
may be carried from the nasal cavity into the adjacent 
cavities referred to, thereby setting up the disease in new 
localities, and thus increasing its extent. I ought, perhaps, 
to remark right here that catarrh is to some degree conta- 
gious ; that is, if we transplant a portion of the discharge 
from a catarrhal nasal cavity to a healthy nasal mucous 
membrane it may create the disease where it did not exist 
before. 

I would again impress the warning that the nose should 
not be cleared with violence. We frequently see per- 
sons, in blowing the nose, take first a deep breath, then, 
closing the nose, make such violent efforts to expel the 
air through it as to cause themselves to become so red 
in the face, through the distention of the blood-vessels, as 
to give one the impression that the head is about ready 
to explode. This is undoubtedly a very efficient method 
of clearing the nasal cavity, as the air is so compressed 
that when the nose is released, it rushes out with almost 
explosive violence ; but it is productive of great mischief, 
and there are, undoubtedly, many cases of ear diseases 
and other serious troubles to which catarrhal patients are 
subject, that are due to this cause alone. 

The Second Stage. — After a time, however, the 
patient finds that although the discharge may be lessened, 
the nasal obstruction still continues, especially in damp 
weather or when he has been exposed to a slight chill or 
dampness. There is also a noticeable change in the voice, 
which acquires the so-called nasal tone. Really this term 
is a misnomer, as the cause of the peculiar quality of voice 
referred to, is a lack of nasal resonance, due to the obstruc- 
tion of the nasal passages of one or both sides. 



Chronic Nasal Catarrh. 29 

As time passes on, the nasal obstruction increases, until 
respiration during sleep is carried on almost entirely 
through the mouth. 

The patient has now become an habitual snorer, much 
to the annoyance of those who sleep in his vicinity, and 
even to his own great inconvenience ; for there are numer- 
ous morbid conditions and really serious diseases, which 
are directly traceable to mouth-breathing, as. we shall take 
occasion to point out more fully at another time. 

When the conditions we have just described are present, 
the disease has reached its second stage, which is charac- 
terized by thickening of the mucous membrane, and growths 
of various sorts. We have here a patient who presents so 
many characteristic features of the disease at this stage, 
that I have asked him to allow me to examine him in your 
presence, so as to illustrate as fully as possible the con- 
ditions usually found in the second stage of catarrh. A 
glance at this gentleman's face is sufficient to discover to 
an experienced eye the fact that he has had catarrh for 
many years. First, we notice that his lips are held slightly 
apart, even when he is not speaking. This is because he is 
obliged to breathe through his mouth, which is an evidence 
of nasal obstruction. We notice, too, that his nose seems 
to be unnaturally broad at the upper part, commonly 
termed the bridge of the nose. This is due to abnormal 
thickening of the bones of the nose at this point, or an en- 
largement of this portion of the nasal cavity from the 
presence of the thickened tissues within. You ob- 
serve, also, that his nose is not perfectly straight with 
the rest of his face. It is twisted a little to one side. 
This, too, is a result of catarrhal disease, and is due to a 
deviation, or bending, of the septum of the nose toward 
one side, one of the most common results of chronic ca- 
tarrh. If we ask this gentleman to speak, the decidedly 
nasal character of his voice is very conspicuous, and is es- 
pecially noticeable if we ask him to utter such words as 
him, pudding, or other words containing the sounds of m 
or ng. Notice that he pronounces him as hib, and pudding 



■?o Third Lecture. 

as puddig. The patient confesses that his friends accuse 
him of being a very loud snorer, and adds that he even some- 
times awakens himself by his noisy breathing. He com- 
plains that he finds his mouth very dry in the morning, 
and his tongue covered by a brown coat, which he charges 
to his liver, supposing it to be indicative of " biliousness." 
Very likely he will be quite surprised when we tell him 
that his liver has nothing whatever to do with the con- 
dition of his tongue, but that the brown coating is really 
a sort of fungus growth, which develops from spores, or 
germs, received from the air. 

Nasal Hypertrophies. — If we use the nasal specu- 
lum, to look into this gentleman's nose, we shall discover 
that the nasal passages seem to be entirely closed. A 
brownish red mass projects from the outer wall of the nasal 
cavity toward the septum, and completely closes the pas- 
sage. If we press upon this red mass with a probe, we 
easily make a depression in it, which quickly fills out again 
when the probe is removed. This is what is called an 
hypertrophy. If we examine the opposite side of the nose, 
we find another hypertrophy, though not so large as on 
the other side. The passage is quite as completely closed, 
however, on account of the bending of the septum of the 
nose toward this side. If, now, I throw into the nostrils 
a spray consisting of a solution of that new and wonder- 
ful anesthetic, cocaine, we shall presently discover that 
these hypertrophies have, to a considerable extent, disap- 
peared, so that we can look beyond them. 

In the meantime, while waiting for this change to occur, 
we will have the patient open his mouth, and allow us to 
examine his throat. Pressing down the tongue, we get a 
view of the throat, and notice two red lumps, one pro- 
jecting from each side. (See Plate IV.) These are hy- 
pertrophied, or overgrown, tonsils. The mucous membrane 
of the entire throat is of a dark red color, and is 
usually thick, and in places hangs into the throat in 
loose folds. The soft palate is also thick, and hangs 




Acute Tonsillitis. 








Chronic Tonsillitis. 



IV. 



Chronic Nasal Catarrh. 31 

•down too far in the throat. The uvula is enlarged and 
elongated. The back wall of the throat, also, has a red 
and angry appearance. The blood-vessels are so much en- 
larged, and stand out so prominently, that their course can 
be traced. The main trunks, with their many branches, 
look much like a great river with its tributaries, as seen 
upon a map. Here and there we see little red patches, 
looking somewhat like warts. These are enlarged, or 
hypertrophied, mucous follicles. We notice that some of 
the larger patches are covered by a tough secretion, which 
we can wipe away with a probe having a little cotton 
wound around the end. If we make the patient draw up 
the soft palate so that we can see higher up in the throat, 
we observe that these same red patches extend upward into 
the back part of the nasal cavity. By the aid of a little 
mirror set at an angle on the end of a long handle, and 
the strong light reflected from a large concave mirror, we 
may look up behind the soft palate into the back portion 
of the nasal cavity, which we find looking very much like 
the throat. We see masses of thickened tissue here and 
there, and in the middle we find standing out prominently, 
a thick red growth looking somewhat like an enlarged ton- 
sil ; and, indeed, this is just what it is — an enlarged pha- 
ryngeal tonsil. (See Plate I.) The two cuts on this plate 
are copies of drawings made from a patient, a young wo- 
man, whose nose was so completely obstructed that no air 
whatever passed through it. Her health was most wretched. 
By removal of the growths, she was restored to health in 
a few weeks. 

Most persons who have chronic throat troubles are proba- 
bly of the opinion that two tonsils are enough for one 
throat, but, as a matter of fact, we have three tonsils, one 
on each side of the throat, and another high up in the mid- 
dle, behind the soft palate. This third tonsil is also en- 
larged, like the rest, from chronic inflammation. By skill- 
ful use of the little mirror, we are able to find still other 
evidences of disease in the nasal cavity. We find in the 
back part of the nose, several other hypertrophies similar 






32 Third Lecture. 

to those -which we found obstructing the nasal passages in 
front ( Plate I.) ; and here and there are masses of green- 
colored mucus adhering to the mucous membrane. The 
method of examining the back part of the nasal cavity is 
shown in the cut on page 5. 

Nasal Polypus. — Now, returning to the examination 
of the nasal cavity through the nostrils, we find that un- 
der the influence of cocaine, the hypertrophies have dis- 
appeared to such an extent that we can look beyond them, 
when the nostrils are stretched widely open ; and in so do- 
ing we see two or three gray-colored masses hanging down 
from the upper part of the nasal cavity, and filling up the 
back portion of the air-passages. If we ask our patient 
to throw his head forward and attempt to blow his nose,, 
we find that these masses come down near the entrance 
of the nostrils. When touched with the probe, we find 
they are soft, almost gelatinous in character. These are 
what are termed polypi. Sometimes they are found grow- 
ing straight out from the side, or the septum, of the nasal 
cavity. Sometimes they are attached to the roof of the 
nasal cavity by a long slender neck. They may be found 
singly, or in masses almost resembling a bunch of grapes. 
Some time ago I removed from a patient's nose between 
thirty and forty of these growths. Both sides were filled 
to overflowing with polypi. The nasal cavity was enor- 
mously enlarged, and the polypi were present in such num- 
bers that they hung down at the back part of the throat. 
Sometimes these polypi are dense and fibrous in character. 
Very frequently, bony or cartilaginous growths may be seen 
projecting out from the nasal septum or the other bony 
structures of the nose. 

When our patient speaks, we notice that his voice is not 
only nasal, but somewhat husky and weak. He has con- 
stantly to clear the throat from a thick and tenacious 
phlegm which accumulates in it. He says that on rising 
in the morning he is greatly annoyed by being obliged to 
" hem " and " hawk " for half an hour, before his voice becomes 



Chronic Nasal Catarrh. 33 

even tolerably clear. All these are the results of nasal ca- 
tarrh in its second stage, as the disease extends into the 
throat, setting up there the same changes which occasion 
so much mischief in the nasal cavity. 

Third Stage. — All persons who pass inrougn the sec- 
ond stage of catarrh do not suffer from all the conditions 
described ; but all are afflicted with more or less of the evil 
consequences which grow out of the overgrowth and thick- 
ening of the various structures of the nose, which are the 
natural results of chronic congestion of these parts. After 
a long time, however, many of these symptoms begin to> 
disappear. The patient finds that he is less troubled witk 
obstruction of the nasal passages. The discharge decreases, 
perhaps disappears entirely. Occasionally, however, pa- 
tients are troubled with a slight itching on one side, just 
within the nostril. To relieve the itching, a small scab is 
removed, which is usually followed by a little blood. The 
scab grows larger and larger, until, after a time, profuse 
bleeding of the nose follows each time the scab is removed. 
This goes on for months or even years, until by and by 
the patient or some physician discovers that there is an 
opening through the septum of the nose from one side to 
the other. The ulcerative process which the presence of 
the scab indicated, has continued until the cartilaginous 
portion of the itching septum has been eaten away. 

In the meantime, the patient has been congratulating" 
himself that he has outgrown the disease, or worn it out. 
The disappearance of the nasal discharge and nasal obstruc- 
tions seem to indicate this. He notices, however, a slight 
impairment of hearing ; and on consulting a specialist im 
ear diseases, finds that he has catarrh of the ear, the ori- 
gin of which was the nasal catarrh, which has extended: 
through the Eustachian tubes to the ears. 

The patient observes that his eyes are red in the morn- 
ing. This is another relic of the frequent chronic catarrhs, 
which have extended from the nasal cavity to the eyes. 

Close contact with the patient will acquaint us with 

c. 



34 Third Lecture. 

another symptom, of which the patient himself is not usu- 
ally aware ; namely, a peculiar fetor of the breath, which 
is characteristic of the third stage of nasal catarrh. The 
patient himself is not conscious of the odor, for the rea- 
son that nature kindly deprived him of the sense of smell 
before this stage of the disease was reached. If we glance 
into the nasal cavities of a patient suffering from catarrh 
in this stage, we find a condition very different from that 
in the. preceding stage. The hypertrophies and thickenings 
have disappeared. The lining of the nose is no longer red 
and congested. There is now no obstruction of the nasal 
passages. There seems, indeed, to be too much room. 
The patient sometimes complains, especially when breath- 
ing cold or dry air, that the air passes through the nasal 
passages so freely and forcibly as to produce unpleasant 
symptoms in the throat. The nasal passages are dry from 
insufficient secretion. Their walls have a gray and shining 
appearance. The mucous membrane seems to be so thin 
as to be almost transparent. Here and there we notice 
little masses of hard, dry crusts, which, when removed and 
examined, are found to have a most disgusting odor. These 
are little masses of secretion which, being too thick to be 
discharged in the ordinary manner, remain where formed, 
and undergo decomposition. Underneath these decaying 
masses, the thin mucous membrane is eroded by the de- 
composing mucus, and finally ulcerates, forming an open 
sore, from which bloody scabs are thrown off, finding exit 
through the nostrils or falling backward into the throat. 
This is the source of the putrescent odor. 

If we look into the throat, it will be found to have the 
same pale color observed in the nose, and a dry, shiny 
appearance. Here and there are small red patches and en- 
larged blood-vessels. The tonsils, like the hypertrophies 
of the nose, have shrunken away. The symptom of which 
the patient himself complains most, is the annoyance of 
" hawking" and " spitting," which is necessitated every morn- 
ing to clear out the throat or to relieve a most unpleasant 
irritation or itching which is frequently experienced there. 



Chronic Nasal Catarrh. 35 

Sometimes he is made wretched by a sensation like 
that of a hair in the throat. This is caused by the presence 
of the enlarged follicles previously described. 

So we find that although our patient may have imag- 
ined that he had outgrown or worn out his catarrh, his last 
condition is really worse than the first. There is really no 
such thing as outgrowing or wearing out the disease. Unless 
it is cured by proper treatment, it marches steadily on from 
the first stage to the last, developing in each case more 
or less of the various symptoms and conditions which have 
been described, with numerous' others which we have not 
taken time to mention. 

At our next lecture we shall consider " The Causes of 
Acute and Chronic Nasal Catarrh." 



FOURTH LECTURE. 



Predisposing (Ecmses of Nasal (Eatarrl). 



This increasingly common malady is usually attributed to 
taking cold ; but a more careful study of the subject clearly 
shows that catarrh owes its origin to a variety of causes, 
and that, in many cases at least, " taking cold " is only 
the exciting, not the real or chief cause of the malady. 

"Wliat is a Cold ? — Before we undertake to classify or 
to definitely state the causes of this disorder, let us briefly 
consider the intimate nature of this disease. As we have 
previously learned, there is in catarrhal conditions a relaxed 
or congested state of the blood-vessels of the affected parts. 
The small blood-vessels have muscular walls, by which 
their size is constantly varied, according to the require- 
ments of the part as regards blood-supply. These deli- 
cate muscles operate in obedience to impulses received 
from certain nerve centers in the brain and the spinal 
cord, known as vaso-motor centers. 

There are two sets of nerves connected with these cen- 
ters, — one set going from the surface of the body and 
passing inward to the centers ; the other set passing from 
the centers to the blood-vessels of the internal parts. It 
thus appears that the outer portion of the body is inti- 
mately related to the inner portion, through the nervous 
mechanism. A relation of the most intimate kind exists 
between the tissues of the back of the neck and those of 
the throat and nose. A more remote relation exists be- 
tween the soles of the feet and the mucous membrane 
lining the air-passages. The effect of an irritant of any 
kind applied to the outside of the body, is, first, a 
contraction of the blood-vessels in those internal parts 
to which the portion irritated is related. These internal 

r 3 6) 



Predisposing Causes of Nasal Catarrh. 37 

parts may be immediately beneath the irritated portion, or 
quite remote. Cold acts as an irritant when, for instance, 
it is applied to the back of the neck, as in case of expos- 
ure to a draft, or to the evaporation of moisture from neg- 
lect to dry the hair. The effect is, at first, contraction of 
the blood-vessels in the mucous membrane lining the nasal 
cavity or the throat, or both. Afterward, however, this con- 
traction is followed by relaxation, and the extent and du- 
ration of the relaxation or congestion is usually in pro- 
portion to the intensity of the irritation produced ; in other 
words, to the degree or continuance of the exposure to 
cold. 

There is thus an apparent and very simple reason for 
the phenomena which occur in taking cold. The conges- 
tion which immediately results, gives to the mucous mem- 
brane its red, glossy appearance, and causes it to swell. 
Irritation is produced, which occasions sneezing. Sneezing 
is a nervous expression on the part of the nasal cavity, 
which exactly corresponds to pain in some other part of 
the body, and is produced in the same way ; namely, by 
compression of the delicate nerve ends by the swollen 
blood-vessels. 

With this brief explanation of the nature of a cold and 
the mode of its production, we have a key to the various 
symptoms attending an acute cold. For example, neural- 
gia, which may affect any part of the body as the result 
of a cold, is caused by congestion of the blood-vessels of 
the sheath which covers the nerve trunk, thus producing 
compression and likewise pain, which would result from 
compression in any other way. Sciatic neuralgia, lum- 
bago, facial neuralgia, hemicrania, or migrain are all oc- 
casioned in this way. The same is likewise true of such 
sensations as soreness and stiffness of the muscles, which 
are so common in colds. The peculiar sensations of the 
skin, as numbness, the abnormal irritability or soreness 
frequently felt in the scalp, stiffness or soreness of the eyes, 
weakness or loss of voice (partial paralysis of the swollen 
vocal cords), profuse secretion of urine, — all these and 



33 



Fourth Lecture. 



numerous others of the varied symptoms attending a com- 
mon cold, are fully explained by the principles briefly 
outlined above. Sometimes the morbid impression is made, 
upon the blood-vessels of the air-passages of the lungs ; 
then the patient has " a cold on the lungs." Acute catarrh 
of the bowels, the bladder, or other parts; may originate 
in the same manner, and all chronic neuralgic affections, 
catarrh of the stomach, bowels, bladder, etc., are invaria- 
bly aggravated by a cold. 

Predisposing Causes of Catarrh. — From the 

foregoing it is evident that catarrh is a disease inti- 
mately connected with the nervous system, and hence, 
that its production must be to some degree dependent upon 
conditions which affect the nervous system. It is evident, 
also, that whatever affects the general system, lowering the 
vital tone, and hence the nerve tone as well, must be a 
predisposing' cause of this disease. 

The immediate or exciting cause of catarrh, whether it 
be exposure to a draught, wetting the feet, exchanging 
heavy for lighter clothing, or similar accident or indiscre- 
tion, is not the real cause of the cold. The exposure to 
which the catarrh is usually attributed, is, in fact, only the 
provoking' cause of a morbid process, favorable conditions 
for which have been previously prepared. In other words, 
it is like the throwing of a lighted match into a powder- 
magazine. It is not the match which explodes ; the match 
simply ignites the powder, and would do no harm if the 
magazine contained none. So with reference to taking 
cold. The causes to which colds and catarrh are ordi- 
narily attributed, do little or no mischief, except when 
brought to bear upon a system prepared for the setting-up 
of the diseased action which we call a cold. This is a 
point of very great practical importance, and we may con- 
sider it with profit, at some length. 

Let us, then, inquire, What are the conditions which 
may be called the real causes of a cold, or which render 
a person susceptible to the influence of the exciting causes 



Predisposing Causes of Nasal Catarrh. 59 

of this disorder ? Some of the most important of these 
conditions we will now consider : — 

1. A Gross State of the Body. — A gross condi- 
tion of the body must be regarded as eminently active among 
the predisposing causes of catarrh. By this we mean such a 
state of the body as is the result of retaining the worn- 
out particles which ought to have been carried off through 
the lungs, skin, liver, kidneys, bowels, and the depuratory, 
or purifying, organs of the body. 

This state may be produced in several ways. It may 
be the result of gross eating; that is, eating foods of a 
clogging character, as excessive quantities of sweets, fats, 
and flesh-meats. It may be the result of eating too much 
in quantity of even the best food. Or it may be the re- 
sult of inattention to the proper care of the body, so that 
the excretory organs become more or less disabled, and 
hence fail to do their work "properly. 

(a.) How does gross eating cause a predisposition to 
catarrh ? — It is well known that sugar and fats are clog- 
ging in their influence. The liver, especially, is literally 
clogged by the free use of fats and sweets. The liberal 
use of flesh-meats results in clogging the whole system. 
Condiments — mustard, pepper, pepper-sauce, and articles 
of this kind — act as irritants, and injure the stomach and 
liver, thus producing general derangements of the body, 
and a morbid and impoverished condition of the blood. 

Chronic indigestion, or dyspepsia, is undoubtedly in 
many cases productive of chronic nasal catarrh. In indi- 
gestion, a considerable part of the food, instead of being 
converted into healthy blood, undergoes fermentative and 
putrefactive changes, by means of which various poisonous 
substances are formed, such as acetic, lactic, butyric, and 
oxalic acids, and various other poisonous matters known 
as ptomaines, which, being absorbed into the blood, act 
as irritants not only to the system in general, but espe- 
cially to the mucous membranes and other tissues which, 
are liable to congestions from changes of temperature or 



4<3 Fourth Lecture. 

other exciting causes. Functional disturbances of the liver 
;are almost always associated with chronic disturbances of 
other digestive organs, as the result of which the liver 
fails to do its duty in converting and eliminating the 
"waste substances of the body, causing an excessive ac- 
cumulation of uric acid and allied substances in the blood 
.and general system. 

(b.) The eating too abundantly, even of proper food, es- 
pecially by persons whose habits are sedentary, produces a 
gross state of the body, which in the highest degree fav- 
ors the development of catarrh. The mucous membrane 
of the nose comes to be used as a sort of depurating sur- 
face, through which effete matters are drained away. This 
fact is shown by chemical analysis, by which it appears 
that the discharges of nasal catarrh contain a large amount 
of cholesterine, a poisonous excretory product which is 
usually carried off through the liver, thus showing that 
the discharges of catarrh are, to some degree at least, 
excretory in character. Unused material in the body, a 
surplus resulting from excessive eating, must be treated 
like so much effete matter, — the result of the natural wear 
and tear of the body, — and must be eliminated in the 
same way that waste matters are removed from the body. 
The clogging of the general system, and the overwork of 
the eliminating organs, are unquestionably powerful pre- 
disposing causes of catarrhal diseases of all sorts. 

(<:.) Inattention to bathing, thus allowing the skin to 
become inactive, is unquestionably one of the most com- 
mon causes of bodily grossness. A neglected skin not only 
fails to do its duty as an excretory organ, but is abnor- 
mally sensitive to change in temperature, moisture, etc., 
thus exposing the individual to a doubly increased danger 
of contracting catarrhal diseases. 

(d.) The use of tobacco, or intemperance of any sort, 
which checks the action of the excretory organs, or clogs 
the system, is productive of this condition. 

(e.) Neglect to supply the body with the proper amount 
of fluid, renders the system unable to rid itself of ac- 



Predisposing Causes of Nasal Catarrh. 41 

cumulating impurities through the excretory organs. Wa- 
ter is a great solvent. It is needed to dissolve the waste 
matters of the system, — the first essential requisite for 
their elimination. Tea, coffee, wines, and similar drinks, 
are not substitutes for water. Their use, in fact, creates 
a demand for an additional quantity of fluid to rid the 
system of the injurious substances which they introduce. 
The free use of water is the best means for maintaining 
a pure state of the blood, and of the body in general, and 
the habit should be cultivated by those who are subject 
to this disease. We shall dwell more particularly upon 
this point in speaking of the proper treatment of catarrh. 

2. Living in unventilated rooms, especially stove-heated 
rooms, which subject the upper part of the body to a high 
temperature, while the lower portion is exposed to cold, 
thus producing habitual derangement of the circulation, is 
a predisposing cause well deserving of mention. 

3. Neglect to clothe the body properly is a predispos- 
ing as well as an exciting cause. Tight-lacing may pro- 
duce a tendency to this disease in women, by causing con- 
gestion of the head. 

4. Heredity. — A cause which ought not to be 
omitted in this enumeration, is heredity. It is a common 
remark by persons suffering from this malady, that they 
have inherited the disease. This is not really the case, 
although it is frequently observed that the disease ap- 
pears in infants seemingly too young to have contracted 
it from ordinary exciting causes. In these cases it is 
probable that a tendency to contract catarrh has been in- 
herited, as is true of most other diseases, but not the dis- 
ease itself. 

The inheritance of disease is usually nothing more than 
a peculiar vulnerability to the causes of disease, or a state 
of body which invites disease. Thus the children of con- 
sumptive, scrofulous, or simply weakly parents, are much 



42 Fourth Lecture. 

more liable to this disease than are others, not because 
they inherit the disease, but because they are less pre- 
pared to resist the exciting - causes of the malady. Men 
who exhaust their systems by the use of tobacco or 
whisky, by dissipation, by gluttony, by abuses of any sort, 
transmit to their children that vulnerability of constitution 
which opens the way not only for chronic catarrh, but for 
all constitutional maladies. It is in this way that the 
children of parents afflicted with catarrh seem to inherit 
the disease from them. There is no doubt that in this 
disease, as in others, a tendency received by heredity may 
be extinguished by a proper regimen begun early in life. 

5- TOO Milch. Coddling. — Too much coddling is 
unquestionably one of the most common predisposing causes 
of catarrh. One who is inured to hardships is able to en- 
dure without injury exposures and privations under which 
one unaccustomed to a similar experience quickly suc- 
cumbs. The habits of civilization — air-tight houses, close 
and unventilated super-heated rooms, even protection of 
the body by clothing required by man in a civilized 
state — are active causes of preventing the development 
of hardihood, as the result of which colds are usually 
taken, and catarrh becomes an ever-present and almost 
universal malady among all civilized people. 

The lumberman in driving logs, wet to his knees all 
day long, and taking every now and then an involuntary 
plunge, suffers no inconvenience, from the sort of exposure 
that would give a man unaccustomed to such a life his 
death cold. The native of Terra del Fuego shelters him- 
self from the wind and sleet of his unfriendly climate, by 
a single bit of skin, which he throws over the shoulder 
most exposed. Surely such a man would not incur taking 
cold from exposure to the draught of an open window. 

Historians tell us that the ancestors of the Anglo-Sax- 
ons wandered over the bleak hill-sides of their chilly 
island, with no other protection than here and there a 
daub of paint. It is not to be supposed, then, that our 



Predisposing Ccmses of Nasal Catarrh. 43 

aboriginal ancestors suffered serious inconvenience in con- 
sequence of making a change of garments. 

When visiting the primitive Indians of Arizona and New 
Mexico, I was informed by the Catholic Sisters in charge 
of the school at Fort Yuma, that the children of the 
Yuma tribe, who, through the efforts of the good Sisters, 
are rapidly becoming civilized, at once become subject to 
colds, catarrhs, and other indispositions after exchanging 
the no-clothing fashion which prevails in that part of the 
country, for pantaloons and petticoats. This fact, indeed, 
stands more in the way of the advancement of the work 
of civilizing this tribe than does any other. The Indian 
boy who has lived all his life in a state of nudity, plunges 
into the stream for a swim, or races about for hours 
through the wet grass of the marshes in quest of seeds or 
mesquite beans for his dinner, and experiences no inconven- 
ience whatever from the wetting which he receives ; but as 
soon as he puts on civilized clothing, he becomes sensitive 
to the same causes of cold which affect other people who 
wear clothes. His skin loses, in part, its ability to regu- 
late temperature, relying largely upon the non-conducting 
covering afforded by the clothing for this protection. In- 
dian men and women who have never acquired the cus- 
tom of wearing hats or bonnets, never take cold in conse- 
quence of going bare-headed. 

We do not wish to be understood as recommending the 
adoption of savage customs in dress as a protection against 
catarrhs, but excessive protection, especially the subjection 
of the body to too high temperature, so common in civi- 
lized communities during cold weather, is certainly produc- 
tive of a vast deal of mischief. 



FIFTH LECTURE. 



feciting Causes of Nasal Olatarrt). 



DURING the cold season, a very large proportion of per- 
sons living in civilized communities find themselves suf- 
fering more or less from this annoying malady ; for a 
"cold" is a disease as much as is consumption or typhoid 
fever. Colds are also frequently contracted even during 
the warm season of the year. Let us now inquire, What 
are the principal exciting causes of that most common of 
all our bodily afflictions, a " cold " ? The various causes 
of colds may be classified under the following heads : — 

1. Disturbances of the circulation by prolonged chilling 
of some portion of the surface of the body. 

2. Contagion. 

3. Imagination. 

Let us consider more at length the particular applica- 
tion of each of these causes. 

1. Usually, and, in the majority of cases, correctly, colds 
are attributed to becoming chilled, getting the feet wet, 
having the hair cut, exchanging heavy under-clothing for 
lighter, or perhaps leaving it off altogether. These are, 
perhaps, among the most common of the immediate causes 
to which colds may be attributed. Let us look a little 
more particularly into these and other causes, and as we 
mean to go to the bottom of this subject, let us begin with 
the feet. Everybody knows that getting the feet wet on 
a cold day, when they are likely to become chilled thereby, 
is a dangerous accident ; and yet, how few people take 
the pains to avert a possible catastrophe by adopting the 
necessary preventives, such as taking a hot foot-bath, dry- 
ing the feet before a fire until warm, etc. ! 

Pei haps it has not occurred to many that a cold may 
be contracted from having the feet damp, even without 

(u) 



Exciting Causes of Nasal Catarrh. 45 

any of the ordinary causes of wetting, such as walking 
in the snow or the rain, or in the grass after the dew 
has fallen, without rubbers. It is quite possible that a per- 
son may take cold through dampness of the feet due to 
perspiration. Profuse sweating of the feet is a symptom 
which very frequently accompanies some forms of nervous 
disease. Many persons are much troubled with sweating 
of the feet whenever vigorous exercise is taken. Such per- 
sons are just as likely to take cold if the feet are allowed 
to become chilled, as if they had been made damp by 
any other means. All persons who wear rubbers, over- 
shoes, or rubber boots, are exposed to the same danger, 
unless the rubbers are frequently removed, so as to give 
the feet an opportunity to dry, and great pains taken to 
keep them constantly warm. 

Persons who consider themselves particularly careful of 
their health, frequently take cold unawares, by getting their 
feet damp, though not positively wet. This is most apt 
to be the result of walking in the damp or wet with 
shoes or boots having thin soles. Sometimes, indeed, the 
feet will be chilled when not made either wet or damp, from 
walking on a cold pavement with thin foot-gear. Any- 
thing which chills the soles of the feet, is sufficient to pro- 
duce a cold, whether the chilling is due to the evapora- 
tion of moisture, or to prolonged contact with some cold 
body without a good non-conductor intervening. It should 
be remembered that leather is by no means the best of 
non-conductors ; it is much inferior to rubber, though bet- 
ter for a foot-cover than rubber, on account of being 
slightly pervious to air. The insertion of a layer of rub- 
ber in the soles of shoes and boots is an improvement in 
their manufacture which we are sure is of real value. 

Imperfect protection of the lower extremities, such as the 
wearing of thin shoes, thin stockings, and thin under-cloth- 
ing, is an exceedingly common practice, and one which is 
unquestionably productive of a vast number of colds. All 
the colds resulting from this practice do not affect the nasal 
cavity, or respiratory tract, or at least their ill effects are 



46 FiftJi Lecture. 

not confined to these regions. Colds contracted by expos- 
ure of the lower extremities, frequently result in catarrh of 
the bowels, bladder, and urinary passages, and sometimes, 
especially in women, in violent inflammation of the 
delicate organs of the pelvis, including cellulitis and peri- 
tonitis, two very dangerous maladies. Women are the 
greater sufferers from this cause, because the greater of- 
fenders. 

If there is anything a woman really admires, it is a small 
shapely foot ; and the idea of dressing the foot with thick 
stockings and thick warm shoes, is one not to be en- 
tertained for a moment by most women. Thousands 
have sacrificed their lives to their vanity. There are 
many persons whose condition of body is such that chilling 
of the feet and legs is a hazard almost as great as that in- 
curred by soldiers under a heavy fire from the enemy. 
The congestion of the internal organs set up by the sud- 
den chilling of the surface of the lower extremities, may 
ignite an inflammatory fire which will only be extinguished 
with the patient's death. People must be taught that these 
exposures are highly dangerous, and that thus incurring 
danger to life, is little short of criminal. 

Probably more colds are taken in spring and fall 
than at other seasons of the year, particularly in early 
spring and late fall. There are many persons who lay off 
their under-garments, or exchange them for thin cotton 
under-clothing, at a certain date in the spring, as the first 
of April or the first of May, for instance, taking account 
only of the time of the year, without reference to the 
weather. These same persons have a set time in the fall 
for putting on the winter under-clothing. These two 
changes constitute about the only modifications of cloth- 
ing which they consider necessary for health. In conse- 
quence, they are constantly taking cold during the seasons 
of the year mentioned ; in the spring, because the warm 
winter under-clothing is laid off too soon ; in the fall, be- 
cause the warm under-garments are not put on soon enough. 
We heartily indorse the remark of the famous English 



Exciting Causes of Nasal Catarrh. 47 

physician who, when asked the question, " When should 
under-clothing be laid off?" remarked, "Lay aside under- 
garments on a midsummer's day, but be careful to put 
them on the next day." 

The fact is, under-garments are needed the year round, 
and we are strongly inclined to believe that for the great 
majority of people, they should be made of some woolen ma- 
terial, and worn almost, the entire year, at least in this cli- 
mate. In summer, on hot days, the thick woolen under-gar- 
ment may be exchanged for lighter garments of the same 
material. On the very hottest days, thin cotton garments 
may be worn with safety, but the arrival of .a cool day, even 
if it be in midsummer, demands that thicker garments should 
be worn. Under-clothing should be adapted to the weather, 
with but little or no reference to the season of the year, ex- 
cept that it should be remembered that a cool day in summer 
is relatively much cooler than a day of the same temper- 
ature in the winter-time, since the vital functions of the 
body have become adjusted to the higher temperature, and 
hence are not so well prepared to stand exposure to cold. 
The influence of weather upon health is a subject which 
every person suffering from catarrh, either affecting the 
nose or any other portion of the respiratory tract, should 
thoroughly understand ; and on another occasion we will 
devote a half-hour to the discussion of the influence of the 
weather upon health. 

Exposure of the arms and chest is even more likely to 
occasion a " cold in the head," or a " cold on the lungs," 
than is exposure of the lower extemities. Many a vain 
woman has sacrificed her life by exposing these portions 
of the body in a decollete dress, at a fashionable ball 
or party. The rule should be considered an inviolable 
one, that portions of the body which are accustomed to 
protection must be protected. Simply cutting the hair, 
thus exposing the neck, not infrequently gives a person a 
severe attack of acute nasal catarrh, or cold in the head. 
Wetting the hair, and neglecting to dry it properly, fre- 
quently occasions the same result, as does also exposing 



48 Fifth Lecture. 

the head without proper covering, by one who has been 1 
accustomed to protect the head. It is noticeable that 
this more frequently occurs in men than in women. It is 
probably because a woman's head-gear is worn for orna- 
ment, and not for protection. At least, one could hardly 
imagine that the tiny combination of ribbons and feathers 
perched on the top of a thick mass of hair surmounting 
the back part of the head, would be of any value as a pro- 
tection for this part of the body against atmospheric 
changes. We have often seen a fashionable woman wear- 
ing this sort of a hat upon the streets, and with no other 
protection for her head, face, and ears, although the mer- 
cury stood close to zero, and all the men in sight had on 
fur caps, and were vigorously rubbing their ears, if those 
members were not protected by mufflers or ear-pieces ; and 
yet the lady seemed to feel no discomfort, and perhaps 
suffered less from the cold and its consequences than did 
the men, who were accustomed to protecting their heads 
with warm fur coverings. Nevertheless, we cannot indorse 
fashionable feminine head-gear which affords no protection 
to the head. Women are much in-door, and hence, when 
out-door, really require more protection for the head than 
do men. 

Another of the causes of cold which we will briefly men- 
tion, is sudden cooling of the body after perspiration in- 
duced by vigorous exercise. A person may take cold from 
this cause in midsummer as well as at any other season 
of the year. We have known violent colds to be con- 
tracted by sitting down in the shade after working or ex- 
ercising in the hot sun. A breezy place, under such cir- 
cumstances, is particularly dangerous, as it increases the 
chill by promoting evaporation. Even a mackintosh, which 
one wears on a damp day to protect himself from taking 
cold, by keeping his clothing dry, may itself become a 
cause of cold. The impervious rubber covering retains 
in the clothing the moisture which is constantly es- 
caping from the body, and thus, after the garment is worn 
some time, the clothing may become quite damp. When. 



Exciting Causes of Nasal Catarrh. 49 

one returns home, and the mackintosh is removed, rapid 
evaporation takes place, and chills and cold may be the 
result. 

Exposure to cold air after perspiration induced by a hot 
bath, is frequently the cause of colds. 

Another deadly cause of colds, to which clergymen and 
school-teachers are particularly exposed, is the spare bed. 
The damp sheets and musty mattresses usually found in 
these death-traps, not infrequently induce colds from which 
the victims never recover. 

Lastly, we may mention as a producer of cold in which 
disturbance of the circulation is the leading factor, one of 
the most potent of all causes, viz., a cold. When a per- 
son has taken a cold, even if it be a slight one, he is al- 
most certain to add to it. The condition of the system 
produced by a cold, occasions a most distressing suscep- 
tibility to influences which would have no effect upon a 
healthy person. The slightest draught, the least degree 
of chilliness, even seemingly unimportant changes in cloth- 
ing, are sufficient to bring on all the symptoms of an 
acute cold — coryza, sneezing, etc. I have known invalids 
who were likely to take cold from simply wetting the 
hands, or from slight changes in the bed-clothing. In- 
deed, it almost seems as though turning over in bed is 
sufficient to give one of these unfortunate persons a cold. 
The unhappy experiences of such persons leads them to 
form the habit of such elaborate protection of the body 
that this susceptibility is intensified and perpetuated. This 
is exceedingly mischievous, as it cultivates a delicate habit 
of body which not only exposes the individual to constant 
danger from causes which do not affect a healthy person, 
but becomes, after a time, a constitutional peculiarity, which 
may be transmitted. The children of such parents are an 
easy prey to catarrh and consumption. 

Contagious Colds. — It has long been suspected that 
some colds, at least, are contagious. It is a matter of com- 
mon observation that in many instances when one mem- 

r>. 



50 Fifth Lecture. 

ber of a family catches a cold, all the other members 
eventually suffer from it. Sometimes a cold of this sort 
afflicts an entire school or community. The explanation 
of the contagion is found in the " germ theory" of disease, 
which has furnished a rational explanation for so many 
mysteries in relation to common maladies, and has also 
furnished the means for their prevention. It is indeed 
more than probable that germs play an important part in 
the origin of all colds, ordinary colds as well as those which 
are distinctly known as contagious. It is well enough 
known that germs or microbes are present in the air at 
all times in immense numbers. What is termed pure air, 
contains a smaller number of germs, while bad air con- 
tains these enemies of life in great numbers. Doubtless, 
some of these germs are much more active as agents in 
the production of catarrhal disease than are others. These 
may be those which give rise to what are termed conta- 
gious colds. But it is well known that the most common mi- 
crobes of the air, and those which are always present, are 
exceedingly active as agents in the production of catarrh of 
the mouth, and of the intestinal tract, under favorable 
conditions. Why, then, may not these same agents be 
equally efficient as a cause of catarrh of the nose ? My the- 
ory of the matter is this : The congestion occasioned by 
the disturbance of the circulation consequent upon expos- 
ure to some of the recognized causes of taking cold, occasions 
the coryza, or watery discharge, while the thicker discharge 
which follows a few hours later, and the continuation of 
the disease, is occasioned by the microbes which are al- 
ways present in the nose in large numbers. This theory 
may be somewhat novel, but it seems to me to present the 
merit of plausibility, at least. The congested vessels fill 
the tissues, and render them less able to defend them- 
selves against the attack of microbes, while the serum 
poured out in such abundance, affords the most favorable 
.condition for the development of the germs. The recent 
studies of specialists in diseases of the eye, seem to have 
.proven that all diseases of the lids which are accompanied 



Exciting Causes of Nasal Catarrh. 5 r 

\>y a mattery discharge, are due to microbes ; and why 
may not the same explanation hold for the nose as well ? 
Future experiments will undoubtedly settle this question, 
and at no distant day. 

A curious example of the contagion of colds is afforded 
by a disease which has attracted considerable attention, 
and which is known as the " stranger's cold." This disease 
occurs on a small bit of land known as St. Kilda's island, 
lying off the coast of Scotland. For more than two hun- 
dred years it has been known that the natives of the island 
of St. Kilda are subject to an attack of influenza immedi- 
ately upon the arrival of a new vessel. 

There seems to be nothing improbable in the account of 
this curious disease. Indeed, travelers have reported a 
parallel observation regarding the islands of Tonga and Sa- 
moa, in the Pacific Ocean. Some months since, the writer 
was told by a traveler who had visited Pitcairn Island, 
that almost the only sickness upon the island for many 
years, had been an influenza which appeared after the ar- 
rival of a ship. 

Imaginary Colds. — There are many persons who 
live in such terror of the causes of colds that merely the 
suggestion of a draught, the sight of an open window, or 
the whistling of the wind through the trees, is sufficient 
to produce a spinal shiver, a nervous chill, and like enough 
a genuine sneeze. I have known such persons to be fright- 
ened into a cold a score of times ; and they suffer far more 
from their constant anxiety, and their unhealthful coddling, 
than they would be at all likely to suffer from colds if they 
took no precautions to prevent them. If a man can take 
the cholera or the yellow fever as the result of fear, cer- 
tainly he may contract a cold from the same cause. These 
persons often make themselves and their friends very miser- 
able by their constant fussiness about everything that can 
have any possible relation to a cold. They are a class 
of hypochondriacs, who ought to be turned over to the 
mind-cure doctors, shut up in a Turkish bath, or hermet- 
ically sealed in an air-tight case. 



SIXTH LECTURE. 



®l)e ^sgiene of Naeal (Jlatarrl). 



Having considered at some length the nature and causes 
of catarrh, let us now give our attention to the practical 
side of the subject — the proper treatment of the disease. 

The Curability of Nasal Catarrh. — First of all, 

let us ask the question, Can nasal catarrh be cured ? 
Before I undertake to answer this query, I must ask 
another, What is meant by " cured " ? If it is meant that 
one who has had nasal catarrh shall be made so well that 
he will never have the disease again, I must say most 
emphatically, " No." It is certainly impossible, by any 
course of treatment or regimen, to make a person better 
than he was before he contracted the disease. It is obvi- 
ous that if a man was born with a tendency to this dis- 
ease, and if this tendency has been strengthened by ex- 
posure to exciting causes to that degree that the disease 
has developed and become chronic, — I say, it is evident 
that in the treatment of such a case, we cannot hope to 
make the patient so well that he cannot contract the dis- 
ease a second time, or a third time, or an indefinite num- 
ber of times, if he is so fortunate as to get rid of the 
active symptoms so many times as that. Nevertheless, 
this disease can be cured in the same sense in which any 
disease can be cured. 

A man may be cured of dyspepsia, and yet he may 
easily abuse his stomach until it again revolts in indiges- 
tion. On the other hand, a man who has once been 
cured of indigestion, may learn how to care for his stom- 
ach, what to eat, how much, to eat, and when to eat, and 
how to conduct himself in relation to his digestion that 
he may not again suffer from the disease. This is what 

(52) 



The Hygiene of Nasal Catarrh. 53 

may be done in cases of catarrh. The man whose stom- 
ach has been injured by bad eating to that degree that it 
has broken down with dyspepsia, can never hope to be 
able to abuse it as he once did, without, a speedy visita- 
tion of punishment ; and a man who has once had nasal 
catarrh, must be admonished that he must not suppose 
that when cured of his malady he is made invulnerable to 
its re-attacks, but that he must learn what have been the 
predisposing and exciting causes in his particular case, and 
then faithfully carry out the system of regimen which may 
be required ; and he must make up his mind to do this 
as a part of his daily routine. In the majority of cases, 
one who will do this may enjoy almost complete immu- 
nity from the disease, even after having suffered from it 
so long that it seemed incurable. 

We must, of course, except from the curable cases those 
who have suffered from the malady to that extent that 
the bones of the nose have become diseased or greatly 
distorted in shape, and cases in which the disease has 
reached that stage in which the natural tissues of the mu- 
cous membrane have disappeared. In these cases, the dis- 
ease can only be palliated. The patient may be made 
more comfortable, his sufferings may be greatly lessened, 
but little more than this can be done. This fact should 
be a most emphatic admonition to all who may be af 
flicted with this malady, even in a moderate degree, to 
give it attention at once, and not put the matter off until 
the opportunity for getting the most satisfactory results 
from treatment has passed by. 

Of first importance in the treatment of nasal catarrh is 
regimen. Nasal catarrh must not be regarded as simply 
a local disorder. It is not a disease of the nose merely, 
but a malady which affects the entire body. Everything, 
therefore, which pertains to the health of the body, is of 
importance in relation to the curing and prevention ot 
this disease. Let us consider the essential features ot 
what may be termed the hygiene of nasal catarrh. 



54 Sixth Lecture. 

Clothing. — The clothing of a person who is suffering 
or has suffered from this malady, is of first importance. 
As remarked on a previous occasion, the under-clothing 
should always be of wool, heavy nn winter, and lighter in 
summer, and always adapted, not only to the season of the 
year, but to the weather. In very cold weather, suscep- 
tible persons may with advantage wear two or three suits 
of under-clothing. It is especially important that the 
limbs should be thoroughly clothed. Stout shoes with 
thick soles, sufficiently roomy to allow the wearing of 
thick woolen stockings, are essential. Felt shoes and thick 
woolen anklets or leggings should be worn when necessary 
for comfort. The feet must be kept warm by some means, 
and preferably by clothing rather than by artificial heat. 

Probably a good share of the colds contracted are due 
to going out into the frosty air from an over-heated room, 
without proper protection. The suicidal practice of wear- 
ing decollete dresses at balls and parties, added to the other 
harmful associations of these occasions, dancing, eating of 
ice-cream and other indigestibles, is unquestionably re- 
sponsible for a vast number of the colds which result not 
only in catarrhs, but far more fatal maladies. 

Outer wraps should always be taken off upon entering 
a warm room from a walk out of doors in cold weather. 
Rubbers, overshoes, and the mackintosh should never be 
worn for a greater length of time than is absolutely re- 
quired, and if they have been worn for so long a time that 
the stockings or under-clothing have become moist from 
retention of the exhalations of the skin, the entire cloth- 
ing should be changed. This is quite as necessary under 
such circumstances as if one had been out in the rain with- 
out proper protection. 

Diet. — The best diet for a person subject to the disease 
which we are considering, will consist chiefly of fruits, 
grains, milk, and a few vegetables. Flesh meats should be 
used sparingly, if at all, certainly not more than once a 
day. Flesh food always contains more or less elements of 



The Hygiene of Nasal Catarrh. ^c 

a clogging nature, — the excretory substances which are 1" 
present in the tissues at the death of the animal, and 
allied matters formed during the first few hours after death. 
These add fuel to the flame in a system already clogged 
with impurities, and hence exercise an unfavorable influ- 
ence in regard to this disease. 

Sugar and sweet foods are also to be avoided. Grains 
supply starch in abundance, which, by the process of di- 
gestion, is converted into sugar, thus supplying the wants 
of the body in this respect to the fullest extent. Certainly, 
any further demand for saccharine material will be readily 
furnished by sweet fruits. By the use of sugar in its ordi- 
nary concentrated form, the system becomes charged with 
unusable material, which must be eliminated as so much 
waste matter. When sugar is taken freely, it also inter- 
feres with the action of the saliva upon the starchy ele- 
ments of the food, by producing a free secretion of mucus 
in the stomach, and occasioning acid fermentation, which 
hinders gastric digestion. The liver is overtasked, and is 
called upon to eliminate saccharine material which can- 
not be used. The subjects of nasal catarrh are almost 
always persons whose nutritive organs are deficient in ac- 
tivity ; hence, every article of food which may add to the 
burden of the excretory organs, should be rigidly excluded, 
or at least taken in the most moderate quantities. 

Butter and other animal fats must also be condemned, — 
because of their clogging influence, and their interference 
with digestion. Cooked fats are particularly harmful. 
Cheese is an article of food fit only for the stomach of a 
scavenger, and should be an abomination in the eyes of a 
catarrhal patient. Rhubarb and onions must also be dis- 
carded on account of the oxalic acid which they contain. 
The urinary secretion of persons suffering from this disease, 
very generally shows the presence of this poisonous sub- 
stance, in combination with lime. This fact certainly con- 
demns the use of all substances likely to introduce the poison 
into the system. The whole list of condiments, including mus- 
tard, pepper, pepper-sauce, ginger, and all hot and irritating 



56 Sixth Lecture. 

sauces, must be stricken from the dietary of the subject of 
nasal catarrh. Tea and coffee must also be interdicted, as well 
as beer, wine, cider, and all alcoholic beverages. Water, 
the only proper drink, should be taken freely, as it encour- 
ages elimination, although the patient should avoid drink- 
ing freely of hot water or hot drinks of any sort in quan- 
tities sufficient to induce perspiration, when likely to be 
exposed to cold draughts, or just before going out of doors. 

Ice-cream, iced water, iced tea, and all frozen or iced 
foods, are exceedingly harmful in this disease. As we have 
previously learned, the chilling of the surface of the body 
is the most potent of all exciting causes of nasal catarrh. 
This is due to the fact that while cold applications at first 
excite a contraction of the blood-vessels, a reaction 
speedily follows in which the blood-vessels are greatly re- 
laxed, a condition which remains for a longer or shorter 
period, according to the intensity of the impression made 
by the cold application, or its duration. Through reflex 
influence, a similar condition is excited in some internal 
area, usually that of the respiratory tract. The intimate 
nervous relation between the stomach and the air-passages, 
both being supplied with branches from the same cranial 
nerve, renders it apparent that the same reflex relation 
may exist between these parts. 

Meals should be taken with regularity, and it is decid- 
edly better that but two meals should be taken daily, or, 
at most, two meals and a light lunch. 

TobaCCO-TJsing in any form must be condemned, be- 
ing one of the most common causes of this disease. The 
tobacco-user who is suffering from this disease, must abstain 
from the weed entirely. An occasional smoke or other 
indulgence in the poison, will prove sufficient to maintain 
the diseased condition, and neutralize all the curative ef- 
forts which nature, aided by the most skillful physician, will 
be able to put forth in his behalf. Swift sung the praises 
of tobacco as a remedy for colic and toothaches-He him- 



The Hygiene of Nasal Catarrh. 57 

self suffered from one of the worst forms of catarrhal di- 
sease of the ear. 

Exercise. — Muscular exercise, either in a well-regu-V 
lated gymnasium or out-door, or, better, both combined, 
constitutes one of the most important curative as well as 
preventive measures applicable to this disease. Exercise 
is not simply a means of developing the muscles. It de- 
velops the nerves as well, improves the nerve tone, aids 
digestion, and stimulates the action of the nutritive or- 
gans. The increased amount of oxygen taken in by the 
lungs, vitalizes and invigorates every vital action. The 
action of the liver is particularly invigorated by active ex- 
ercise. The increased vigor of the muscles of the dia- 
phragm, aids the circulation of the liver in such a way as 
to greatly facilitate its blood-purifying processes. The 
sufferer from catarrh should lay down for himself a regu- 
lar routine of vigorous muscular exercises which will bring 
into play the entire muscular system. These exercises 
should be taken with the same regularity as should the 
meals, and should be sufficient to develop the full powers 
of the body, although extreme fatigue or exhaustion should 
be avoided, as this condition is one which particularly favors 
the contraction of a cold upon slight exposure. Horseback 
exercise, mountain climbing, boating, and, in fact, all out- 
door recreations, are to be commended to persons suffering 
from this disease. 

Poor air and artificial heat, the inevitable results of 
the common method of heating, are greatly productive 
of catarrhal disease. The stove-heating and furnace-roast- 
ing which prevail in most civilized homes, cannot be too 
strongly condemned. A room heated by a stove is cer- 
tain to be badly ventilated, and to expose the feet of the 
occupants to chilling from the layers of cold air which are 
invariably found near the floor. The upper part of the 
room, where the least warmth is really needed, is usually 
over-heated, while at the floor, the air may be fifteen or 
twenty degrees below the proper point. Furnace-heated 



58 Sixth Lecture. 

houses are generally poorly ventilated, the common ar- 
rangement being to supply the furnace with air from the 
basement, or from a vestibule or hallway, so that the same 
air is used over and over. This secures a great economy 
in fuel, but a great waste of health. A constant fresh-air 
supply, direct from out-doors, heated by a furnace, steam 
coil, or a jacketed stove, is essential, and the foul air 
should be removed by means of ventilating shafts or ducts 
so arranged as to direct the foul and cold air from the 
floor. This will insure perfect circulation of air, and air 
of the maximum degree of purity, provided the openings 
are of the proper size. At least one square foot of regis- 
ter surface should be supplied for every three persons occu- 
pying dwelling-houses. When ventilating ducts alone are 
used, without a fresh-air supply, the result is a constant 
influx of cold air through the doors and windows. Cold 
air even enters through the walls of a dwelling. Brick, 
mortar, wood, and sandstone are pervious to air to a de- 
gree seldom appreciated. 

Cold draughts, which are so mischievous for persons sus- 
ceptible to colds, are often encountered in a room which 
is not properly heated and ventilated, and that without 
any opening for draught being apparent. For instance, a 
person sitting by a window will feel a draught upon the 
head or neck when there is no perceptible opening through 
which air can enter. The same will sometimes be experi- 
enced when sitting near an outside wall. These draughts 
are simply downward currents occasioned by the contact of 
the air of the room with the cold windows of the outer 
walls. 

Sleep. — In this, as in all other chronic diseases, abund- 
ance of sleep is essential. Sleep is nature's sweet restorer, 
not only from the results of the natural wear and tear of 
the body from labor, but from the ravages of disease. 
Both repair of natural waste and the restoration of diseased 
or disabled parts, take place during sleep almost entirely ; 
hence the importance of a sufficiency of this natural heal- 



The Hygiene of Nasal Catarrh. 59 

ing agent. The conditions during sleep are also of great- 
est importance. Sleeping-rooms should be well ventilated, 
the fresh air being admitted warm, and in such a manner 
that draughts will not fall upon the patient. That a draught 
may be avoided, however, the bed should be placed so 
that the entire body, and not a single part only, will 
be in the current. For some reason, perhaps not easily 
explicable, one seldom takes cold out of doors, even though 
exposed to very cold winds, while a pencil of cold air 
striking upon the back of the neck, through a crack, may 
be the starting-point of a severe cold in the head, or of 
a violent sore throat. Persons who are particularly sus- 
ceptible to draughts, and we cannot avoid them altogether, 
may protect themselves against their harmful influence by 
wearing a woolen night-cap. By all means run no risk. 

The sleeping-room, as well as the body, must receive 
consideration. A damp bed has not infrequently proved 
to be a death-bed. A bed in an unheated chamber is al- 
ways damp in the winter-time. Vapors distilled from the 
kitchen and laundry are dispersed through the dwelling, 
and are condensed in unheated rooms, so that an ordinary 
house having some rooms heated and others unheated, is 
a veritable distillery. This is why the sheets of a bed in 
a cold bedroom are always damp. To sleep in such a bed 
is about equivalent to an old-fashioned cold wet-sheet 
pack, with the refrigeration continually re-enforced by 
applications of cold water ; for it is not simply the sheets 
that are damp ; the mattress, the blankets, the pillows, — 
everything about the bed, — possesses the same deadly 
quality of chilly dampness. Look out for damp beds. If 
away from home, dodge the spare bed as you would the 
lock-up or pest-house. 

Every article of clothing worn during the day should be 
laid aside at night. Night-clothing should consist of a 
long woolen gown reaching from neck to wrists and an- 
kles. If the feet are habitually cold, warm woolen bed- 
socks, and, if necessary, leggings in addition, should be 
worn. Natural heat is much to be preferred to artificial. 



SEVENTH LECTURE. 



$lje treatment of Nasal (Eatarrf), 



We have now come to the most important and prac- 
tical part of this subject. The treatment of nasal catarrh 
has afforded a rich field for quacks, and has been a source 
of almost infinite annoyance to physicians. It is only re- 
cently, and since the subject has been taken up by scien- 
tific specialists, that the disease has been treated in 
anything like a successful manner. We have no universal 
panacea. The disease is one which possesses marked in- 
dividual peculiarities, and can be successfully treated only 
by a careful adaptation of remedies to individual cases. In 
the first place, we must condemn utterly the use of any 
of the popular catarrh specifics, inhalants, etc. These rem- 
edies are usually such as have proven successful in a few 
instances, and will benefit a certain proportion of cases, 
but are quite as likely to do harm to a greater number. 
The various popular nostrums advertised for the cure of 
catarrh, are composed of substances which have been 
well known to the medical profession for years, and pos- 
sess none of the specific virtues which are attributed to 
them. 

The successful treatment of nasal catarrh includes — 

1. Proper hygiene. 

2. Measures addressed to the system in general. 

3. Measures addressed to the local disease. 

The hygienic management of the disease we have al- 
ready dwelt upon at sufficient length. Incidentally, also, 
in our consideration of the hygiene of catarrh, we have 
considered some of the most general measures of treat- 
ment, and perhaps need not dwell further upon this, ex- 
cept in connection with the treatment, of special condi- 
tions; so to make our subject of as much practical value 

(60) 



The Treatment of Nasal Catarrh. 61 

as possible, we will proceed at once to the consideration 
of— 

How to Treat a Common Cold. — As has been 

remarked, a "cold in the head" is simply an acute ca- 
tarrh of the nasal mucous membrane. The things to 
be accomplished by curative measures are — 

1. The removal of exciting causes, and the taking of spe- 
cial precautions against further exposure. 

2. A restoration of the balance of the circulation, the 
disturbance of which, through the influence of chill upon 
the nervous system, is the usual exciting cause of a cold. 

3. Local treatment for the relief of the local affection. 

The best means for the accomplishment of these ob- 
jects, are so simple that they may generally be found at 
hand ready for use. 

I. If the feet have been wet or chilled, take a hot foot- 
bath, or dry the feet and rub them until warm. If the 
whole body has been chilled, the circulation should be 
stimulated by means of hot drinks, such as hot water, hot 
lemonade, or any of the simple domestic " herb teas, " omit- 
ting from the category such irritating substances as gin- 
ger, capsicum, and lobelia. Extra wraps should also be 
added. If possible, the patient should go to bed, place 
a hot brick to his feet, and wrap himself with woolen 
blankets. When these conveniences are not at hand, vig- 
orous exercise, either in the open air or in-door, may be 
substituted with entire success by persons in robust health. 
Sneezing, which many persons regard as a danger-signal, 
indicating that a cold is likely to be contracted, is, as 
has been previously remarked, really nature's first effort of 
resistance against the encroaching disorder which we com- 
monly call a cold. A hearty sneeze agitates the whole 
body, and is usually accompanied by a convulsive jerk of 
a large portion of the five hundred muscles which com- 
pose the muscular system. A sneeze is, in short, a vigor- 
ous kind of muscular exercise, which is intended by na- 
ture to restore the balance of the circulation, and thus an- 



^2 Seventh Lecture. 

tagonize the cold. A walk or run in the open air, or 
any other kind of vigorous exercise, will operate bene- 
ficially in the same way. 

2. The measures already mentioned are to some degree 
preventive as well as curative in character, acting not 
only to remove the cause of a cold, but the evil effects 
which may have been already produced. There are, how- 
ever, other efficient measures which act still more vigor- 
ously upon the nervous system, and aid in the restora- 
tion of an even balance in the circulation. Among these 
may be mentioned a hot bath, which may consist of a 
simple hot full bath, a vapor or a hot-air bath, a Turkish 
or a Russian bath, a wet-sheet or a dry pack. What is 
desired, is that vigorous perspiration should be induced. 
Here are some of the most convenient ways for accom- 
plishing this result in an ordinary household : — 

A Vapor Bath. — Seat the patient upon a wet towel 
in a cane-seated chair, with a pail or a small tub of hot 
water placed beneath. Wrap him with blankets, and care- 
fully place in the tub, one by one, heated flat-irons or 
bricks, which may be conveniently handled by means of a 
string or a wire attached. The bricks should not be 
plunged suddenly into the tub, as that would produce too 
large a volume of steam, but should be slowly let down 
into the water, that the generation of the steam may be 
properly regulated. 

A vapor bath may be given while in bed, by placing 
hot bricks wrapped in moist cloths alongside the patient, 
being careful not to place them against the body, and 
elevating the bed-clothing by means of a frame-work 
made of bent hoops or wires. 

Still another method of giving a vapor bath, is to place 
a perforated wooden board in a full bath-tub, resting it 
three or four inches above the bottom of the tub. Place 
the patient on this, and allow the hot water to run along 
the bottom of the tub and out at the discharge pipe. By 
covering the tub with a blanket, a very effective vapor 
bath may be obtained. 



The Treatment of Nasal Catarrh. 63 

A Hot-Air Bath. — Seat the patient in the chair as for 
a vapor bath, placing underneath the chair a saucer con- 
taining an ounce or two of alcohol. Before lighting the 
alcohol, set the saucer in a pan containing a small amount 
of water, so that any overflow of alcohol will not result 
in damage. 

A Pack. — The method of giving a wet-sheet pack, is 
too well known to require description. A dry pack is taken 
by wrapping the patient in blankets, placing hot bottles 
at the feet and sides, and giving hot drinks. Hot drinks 
should be copiously given in connection with all the baths 
described, both before and during the bath. If a vigor- 
ous effect is desired, the sweating begun in the vapor or 
the hot-air bath, may be continued by means of a dry 
pack. 

After taking a bath of this sort, the patient should go 
directly to bed, and should remain there until the cold 
is substantially cured, being careful to keep warmly cov- 
ered, maintaining, if possible, a sufficient degree of per- 
spiration to keep the skin slightly moist. 

As has been pointed out, the essential morbid condition 
in a cold, is a dilation of the blood-vessels of the affected 
part, the immediate cause of which is a disturbed state 
of the nerve centers of the spinal cord, which control 
them. It is thus evident that the real disease is located 
in the spine, hence it is proper that treatment should be 
addressed to this part. Among the most important meas- 
ures of treatment for a cold of the head, throat, or lungs, 
is the application of heat to the upper portion of the spine. 
Heat may be applied in the form of fomentations of flan- 
nel cloths wrung out of hot water, bags filled with hot 
water, heated bags of sand or salt, hot bricks or bottles, 
or other similar means. The effect of the heat is intensi- 
fied, and to some degree prolonged, by the addition of 
mustard to the water from which the cloths are wrung, 
in the proportion of a tablespoonful of mustard to a quart 
of water. A very light mustard plaster, allowed to re- 
main on just long enough to cause redness of the skin 



64 Seventh Lecture. 

without blistering, may be advantageously used, although, 
on the whole, the continued application of heat is to be 
preferred to any other form of counter-irritant. The re- 
lief afforded by this measure of treatment, is often very 
prompt and very remarkable. The pain at the back of the 
head, stiffness of the neck, and similar symptoms which 
frequently accompany a cold, quickly yield to these ap- 
plications. 

If a hot bath or other means by which perspiration is 
induced, is not sufficient in its first application, it may 
be repeated once or twice; but it should be distinctly un- 
derstood that the application of hot baths day after 
day, is not a proper mode of treatment for the relief 
of a cold. The effect of such a course is usually to ag- 
gravate the malady, by keeping the system of the patient 
in a constant state of susceptibility to abnormal disturb- 
ances of the circulation. The skin is relaxed, rendered 
sensitive, and unable to defend itself against changes of 
temperature; hence if the cold is not subsequently ''broken" 
by one or two hot baths, accompanied by the other treat- 
ment mentioned, the sweating should be discontinued, and 
the spinal applications, combined with measures calculated 
to harden the skin, should be employed. Among the 
best of these are the salt-rub, which consists in rubbing the 
whole body vigorously with moist salt ; a saline sponge- 
bath, — sponging the body with a tepid solution of salt, a 
tablespoonful to the quart; — and a vinegar sponge-bath. 
Cold bathing has very much the same effect, though less 
intense. After a bath of any sort, the body should be 
well rubbed with olive or cocoanut oil, or fine vaseline, as 
a protection. This, indeed, is a precaution which persons 
subject to colds should always take after a warm bath. 

Local Treatment for a Cold. — The most disagreeable 
local symptoms attending an acute cold in the head, are 
coryza, or a watery discharge from the nose, obstructed 
nasal breathing, and distressing pain just below the eye- 
brows. These symptoms may be greatly ameliorated, and 
the cure of the disease expedited, by the employment of 



The Treatment of Nasal Catarrh. 65 

some local measures, only a few of the most effective of 
which, we have room to mention. 

Inhalants. — The inhalation of the vapor of strong" am- 
monia water, strong spirits of camphor, the vapor of bal- 
sam of benzoin, tar, oil of eucalyptus, and especially of 
menthol, which is now sold at nearly all drug-stores,, 
placed in convenient inhaling tubes, frequently gives 
great relief to the coryza and the stuffed feeling of the 
nasal passages, by stimulating the dilated blood-vessels 
to contract. See pagej2oand Nos. 42, 4.J. These meas- 
ure^ are not effective, however, unless employed at an: 
early stage, and should then be frequently repeated, per- 
haps once or twice every hour during the first forty-eight 
hours after the cold has been contracted. 

Snuffs. — We do not recommend the taking of snuff of 
any sort, as a habit. There is, nevertheless, some effi- 
ciency in the insufflation of certain substances in the form 
of powder, especially in the early stages of a cold. Among" 
the best preparations of this sort are Nos. 26, 31, 32, jj % 

34, 35- 

Solutions. — On the whole, medicated solutions are, per- 
haps, less useful in the treatment of the first stages of a 
cold than the powders or vapors which have been de- 
scribed. Nevertheless, there are a few solutions which are 
of real service, and should be mentioned first of all, because 
of their efficiency. A spray of a four-per-cent solution of 
cocaine, thrown into the nostrils every hour, is the most 
efficient of all remedies, if we except the powder prepared 
from the same drug, in relieving the local symptoms of an 
acute cold. 

A solution of listerine, one part to eight or ten of wa- 
ter, used as a spray, is also an efficient remedy. What 
the mucous membrane requires, when acutely congested^. 
is mild stimulation, but not irritation ; hence, everything- 
of an irritating character should be avoided. A solution: 
of common salt, two drams to a pint of water, used as a. 
spray, will sometimes afford relief. 



66 Seventh Lecture. 

Heat applied to the" face and forehead by means of a 
sponge dipped in hot water, affords great relief to head- 
ache and faceache, and undoubtedly to some degree les-* 
sens the congestion of the nasal mucous membrane. 

Diet. — It is important that something should be said 
respecting diet, in the treatment of this condition. For 
the first twenty-four hours, the staple article of diet should 
be hot water. A little milk or gruel, or better yet, a few 
bunches of grapes or other juicy fruit, may be allowed, 
but hot water is certainly to be preferred, and the more 
the better It is hardly probable that the patient will 
take too much of this efficient detergent. In a cold, there 
is an obstructed condition of the emunctories, or cleans- 
ing organs, of the body. Hot water greatly aids the elim- 
ination of the effete products which are accumulated in the 
system, and thus hastens the termination of the abnormal 
effort made to eliminate waste products from the nose. 
Two or three quarts of hot water may be swallowed every 
two or three hours during the first stages of a cold, with 
great advantage. Meat, and all rich and stimulating arti- 
cles, should be scrupulously avoided. Milk in moderate 
quantity, with fruits and grains simply prepared, should 
constitute the diet. 

As has previously been remarked, it is important that a 
person suffering from an acute cold should protect him- 
self from exposure. On this account, he should remain in 
bed for the first twenty-four hours. 

We have endeavored to sketch in the foregoing what 
long experience and observation has taught us to be the 
rational method of treating an ordinary cold. That there 
is no other means by which it can be successfully man- 
aged, we will not say. We have known, in fact, of in- 
stances in which persons engaged in out-door employ- 
ments, have effectually cured a cold by a long drive in a 
bracing wind, or a vigorous day's work in a keen atmos- 
phere. It is not to be questioned that the inhalation of 
.cold air acts as a local stimulant, and the dense oxygen 
.inhaled under such circumstances, together with vigorous 



The Treatment of Nasal Catarrh. 67 

exercise, stimulates both the circulation and the process 
of elimination, and thus the >very measure which would 
seem likely to aggravate a cold, operates as a cure ; but 
only persons of vigorous constitution, and those accus- 
tomed to an out-door life, are likely to succeed by this 
method. Most certainly unsuccessful will be any method 
of treatment which combines out-door exposures with sweat- 
ing baths and other eliminative treatment commonly em- 
ployed. We have known persons to sweat themselves 
into a state of great debility and weakness, in the at- 
tempt to cure a cold, thus constantly augmenting the 
malady by their ill-advised procedures. Again, we wish 
to emphasize the statement that if a cold is not substan- 
tially relieved, or broken, within the first forty-eight hours 
by the application of two or three hot baths, these meas- 
ures of treatment will not prove effectual, and if continued, 
will probably only aggravate the cold. 

Hardening- — As previously remarked, one of the 
most potent causes of nasal catarrh is what might be 
termed coddling. The hardy denizen of the forest, living 
almost in a state of nudity, exposed to extreme heat and 
cold, winds and storms, and but scantily protected from 
either by his rude hut, has no use for a specialist in the 
treatment of nasal catarrh. A naked Indian was once 
asked by a white man, who was uncomfortably cold, al- 
though clad in thick woolen garments, fur cap and gloves, 
whether he was not cold. The Indian asked in reply, 
"Is your face cold?" Receiving a negative answer, he 
said, " Indian all face. " He saw no reason why his naked 
arms and thighs should suffer from the cold more than 
his face; and they did not, simply because, by constant 
exposure, all parts of his body had become accustomed to 
maintaining their own warmth without artificial heat. 

While we are not prepared to advocate the savage ex- 
treme in clothing, or no clothing, as a remedy for catarrh; 
yet we would say that without doubt one of the primal 



6'S Seventh Lecture. 

causes of this malady is weakening of the resisting forces 
of the body by excessive warmth. 

The woodman seldom takes cold, notwithstanding some 
conditions which would hazard the life of those accustomed 
to ordinary modes of living. The log-driver of the lum- 
ber woods is wet to the skin the most of the time, and 
at night lies down in his cold shanty, without removing 
his garments, yet does not take his " death cold," neither 
does he get rheumatism, but to all appearance suffers 
little from his amphibious life. To the sufferer from nasal 
catarrh, I do not say, Subject yourself to like exposures ; 
for very likely should you undertake this, you would either 
kill yourself outright, contract hopeless deafness, or bring 
on a rheumatic attack which might cripple you for life ;, 
but, I do recommend the subject of catarrh to avoid over- 
coddling, and to endeavor to educate himself out of his ex- 
treme susceptibility. In other words, he should subject 
himself to a species of discipline which might be consid- 
ered a sort of hardening process. This ought to consist 
particularly in the education of the skin, teaching it to 
properly regulate its circulation under adverse circum- 
stances. This involves the education of the nervous sys- 
tem as well. I would say to the subject of this disease, 
when winter approaches, do not shut yourself up in stove, 
steam, or furnace heated rooms, but, instead, go out of 
doors a portion of every day. Go out in all kinds of 
weather, taking care, of course, to protect yourself with 
proper clothing, thus keeping yourself accustomed to out- 
door air. By this means, you may acquire the ability 
to withstand exposure to cold, without injury. Do not 
run away to Florida or California, or some other much- 
vaunted climate, to escape Jack Frost. Cold air is a friend, 
often in disguise, perhaps, but nevertheless one of the very 
best of friends to health. 

Bathing, particularly in cool water, if practiced daily 
or tri-weekly, will do much to educate the skin in the di- 
rection desired. Sea-bathing is on this account advanta- 



The Treatment of Nasal Catarrh. 6g 

geous, and a sea-bath may be taken at home at any time, by 
the addition of a tablespoonful of salt to a quart of water. 
The body, well sponged with this solution at a tempera- 
ture of about 75 , and afterward briskly rubbed with a 
rough towel to secure thorough reaction, is protected in a 
most efficient manner against any evil effects of cold air. 
Sudden changes of temperature, rather than the degree of 
exposure to severe cold, is one of the most exciting causes 
of nasal catarrh ; but the system may even become accus- 
tomed to changes of this sort. The cold-air bath, taken 
in increasing degrees, first exposing an arm, then an arm 
and a shoulder, then both arms, then one leg, then both, 
and thus portion by portion, until the entire surface of the 
body is uncovered, first for a few seconds, then for half a 
minute, next for a minute, and finally for five minutes or 
longer, combining the exposure with exercise sufficient to 
keep the blood circulating, is an excellent preventive 
against taking cold. 

Dr. Brown-Sequard has suggested that the back of the 
neck, perhaps the most vulnerable portion of the body, 
may be thus anti-catarrhally disciplined, by means of a 
pair of bellows, with which an air-current is blown upon 
the neck, first for a few seconds, then for longer periods, 
increased from day to day, till finally any amount of ex- 
posure of this sensitive part to cold draughts, will fail to 
produce sore throat or a cold in the head. 

The feet, also, may be accustomed to being wet with 
cold water, and their susceptibility to this kind of expos- 
ure overcome. All animals go about with wet feet with- 
out harm resulting, and the Indian wears his wet mocca- 
sins a week or more without change, and takes no cold. 
Dip the feet in cold water for a few seconds at first, then 
for longer and longer periods, until they can endure a cold 
bath for half an hour, and this source of danger will be 
overcome. 

When one considers the fact stated by an eminent his- 
torian, that for a thousand years not a man, woman, or 
child in all Europe took a bath, he does not wonder that 



JO Seventh Lecture. 

scrofula in multitudinous forms, and various kinds of plagues 
were so prevalent during that period as to destroy more 
than one third of the entire inhabitants of the Old World. 

Prevention 6f Contagion.— Contagious colds may 
be prevented by avoiding contact with persons suffering 
from this form of disease. Perhaps it will be safe to re- 
gard all colds as contagious. Probably they are, to some 
degree. Hence, a person suffering from a cold should be 
quarantined to a sufficient extent to confine the handker- 
chief, towel, and allied articles to his exclusive use. The 
use of a towel or a handkerchief in common, not infrequent 
in families in humble circumstances, is unquestionably a 
cause of the extension of catarrhal diseases of the nasal 
cavity, and of grave forms of disease of the eye, which 
sometimes result in blindness. It is possible that inflam- 
mation of the eyes may be occasioned by wiping the eyes 
with a handkerchief soiled by discharges from a catarrhal 
nasal cavity. Kissing may be another means by which 
contagious colds are communicated. Promiscuous kissing 
is intolerable under any circumstances ; and a person suf- 
fering from a cold or catarrh may be the means of com- 
municating the disease to children. 

Catarrhal diseases may sometimes be occasioned by the 
fondling of lap-dogs and other animals, which are subject 
to this affection, as well as are human beings. 

Hygiene VS. Heredity. — One of the most benefi- 
cent gifts of modern medical studies, is the development 
of the fact that hereditary tendencies may be stamped out 
by a proper regimen, begun at a sufficiently early period 
of life. Parents who are themselves the subject of catarrhal 
disease, should recognize the tendency which they have 
transmitted to their children, and begin at the very earliest 
period of infancy a course of hygienic care, which, perse- 
vered in, may be relied upon to eradicate inherited dis- 
position to catarrhal disease. 



EIGHTH LECTURE. 



3ll)c Cocai treatment of (Eljronic ;Nasal (Eatarrl). 



WHEN catarrh has existed for such a length of time 
that it has become a constant condition, it is said to be 
chronic. In many cases of chronic catarrh, the most 
prominent feature of the disease in its simplest form, — a 
profuse discharge, — is not always present, but often dis- 
appears almost entirely under favorable conditions. The 
discharge returns, however, whenever there is the slight- 
est exposure to the exciting causes of cold. In other 
cases, the discharge is constant and abundant. In still 
another class of cases, there has never been any great 
amount of discharge present, and an examination will 
show that the mucous membrane is unnaturally dry. The 
passages, instead of being obstructed, are larger than 
those of a healthy person. In all of these cases, there 
will be found some abnormality of secretion. If not pro- 
fuse, it is likely to be thick and viscid, adhering in small 
quantities to various parts of the nasal cavity, or forming- 
dry plugs, which obstruct the nasal passages. These cases 
all require thorough daily cleansing of the nasal cavity. 

How to Cleanse the Nasal Cavity.— There are 

various methods by which the cavity of the nose may be 
cleansed. The first essential is a proper solution. Alka- 
line solutions are most suitable for this purpose, for three 
reasons : First, they best dissolve the viscid or hardened 
mucus ; Second, alkaline solutions, when brought in con- 
tact with the mucous membrane, stimulate the contraction 
of its blood-vessels ; Third, solutions of this character are 
also less irritating to the mucous membrane than any 
other. 

Pure water possesses none of these advantages. The 

(71) 



72 Eighth Lecture. 

fluid naturally secreted by the nasal mucous membrane, is 
slightly saline. When pure water is injected into the na- 
sal cavity, it is absorbed too rapidly by the mucous mem- 
brane, so that it becomes quickly swollen, producing press- 
ure upon the sensitive nerves, thus giving pain. The ad- 
dition of a small quantity of common salt or carbonate of 
soda, increases the specific gravity of the water, giving it 
more nearly the character of the normal nasal fluid. The 
amount of salt required to produce a solution most nearly 
corresponding with the natural fluid, is one dram, or an 
«ven teaspoonful, to a pint of water. Both common salt 
and carbonate of soda, especially the latter, possess the 
property of dissolving with readiness the nasal mucus." 
Borax also possesses this property to some degree. These 
substances, therefore, are the proper ones for use in mak- 
ing the solution. The following formulas are thoroughly 
satisfactory : Nos. i, 2, j, /f.. 

The temperature of the solution is a matter of no small 
importance. The water employed for cleansing the nasal 
cavity, should never be at a temperature lower than that 
of the body, or about ioo°, and an extensive experience 
in the use of solutions of various substances and different 
temperatures, has convinced me that hot water is more 
•effective than warm. I had long held the belief that hot 
water would be found as effective in the treatment of 
catarrh of the nose as it is known to be in other diseases, 
but had been deterred from making decisive experi- 
ments, by the belief that the thinness of the tissues 
lining the nasal cavity was such that water of a high tem- 
perature would be intolerable. On making experiments, 
however, I found to my surprise that a very high temper- 
ature was borne without discomfort, and that a tempera- 
ture considerably above that of the body was more com- 
fortable than a lower temperature. In my experiments, a 
temperature of 130 to 140 , taken in the reservoir, was 
found to be borne without discomfort. I believe that 
the temperature of the douche should be rarely iess than 
J20° and ' may be employed at 130 in most cases, and 



The Local Treatment of Chronic Nasal Catarrh. 73 

even higher in some. The solution reaches the nasal cavity 
at a temperature several degrees lower than this. 

Having our solutions prepared, we are now ready for 
the operation of cleansing the nasal cavity, which is a very 
important part of the treatment of all forms of nasal ca- 
tarrh, and should be thoroughly understood and carefully 
practiced. 

Of the several methods by which the cavity may be 
cleansed, some possess special advantages, such as sim- 
plicity, freedom from danger, etc. We shall mention first 
the most simple methods, which do not require other ap- 
pliances than those which are found in every household. 

First Method. — The simplest and most efficient method 
of cleansing the nasal cavity, consists in drawing water 
into the nose from the hand, snuffing it up with sufficient 
vigor to expose the whole surface to the cleansing action. 
After the solution has been prepared, care being taken to 
give it the proper temperature, a portion should be dipped 
up in the palm of the hand, shaped so as to form a scoop 
for the purpose, and, with the head bent forward so as to 
make the line of the face nearly horizontal, the water 
should be snuffed up strongly, first into one nostril, then 
into the other ; refilling the hand, the head should be 
placed at an angle with the body of forty-five degrees, or 
about half way between the perpendicular and horizontal 
plane, and the operation repeated. Filling the hand again, 
it should be brought to the nose with the head held as 
nearly in a perpendicular position as possible, the water 
being snuffed as before. By snuffing the water into the 
nostrils with the head held in these three positions, the 
whole nasal cavity, and even the extreme back portion, 
may be thoroughly cleansed. A sufficient amount of wa- 
ter should be used in each position, to secure the thorough 
cleansing of the nasal cavities from every particle of co- 
hering mucus, — a condition which will be indicated by the 
readiness with which the air can be drawn through the nos- 
trils, and the sense of comfort and cleanliness which will be 
experienced when the cleansing is effectively performed. 



74 Eighth Lecture. 

For cleansing solutions, use Nos. i, 2, j, ^, adding four 
times the quantity of water indicated in the prescription. 

Second Method. — A somewhat more convenient mode of 
cleansing the nasal cavities, consists in substituting a 
sponge for the hand. The sponge, being saturated with 
the cleansing solution, is brought to the nose with the 
head held in the different positions previously indicated, 
and placed over the nostrils in such a way as to insure 
the entrance of the fluid into the nostrils when the air is 
drawn through the sponge. The entrance of the air and 
water together, which is secured by this method as well 
as the preceding, is favorable to the most thorough cleans- 
ing, as the water is broken into a coarse spray, which 
strikes forcibly the various portions of the membrane, and' 
dislodges the adhering mucus. Use Nos. /, 2, j, 4., add- 
ing four times the quantity of water indicated. 

Third Method. — The nasal douche is one of the oldest 
methods in use for cleansing the nasal cavity, and when 
properly used, is a very satisfactory one. The requisite 
conditions for its proper use are : (1.) A reservoir contain- 
ing the water, which must be placed just above the level 
of the head, so that the water will flow gently through 
the nasal cavities without too great force. The syphon 
syringe (Fig. 3.) is recommended for this purpose. (2.) The 
mouth should be held open, with the head inclined slightly 
forward. (3.) The patient should avoid swallowing while 
taking the douche. These directions are necessary to 
avoid the one danger connected with the employment of 
this method, namely, that of forcing a portion, of the fluid 
through the Eustachian tubes into the middle ear, and thus 
setting up an acute inflammation, which may result in par- 
tial deafness. This accident has occurred so frequently in 
connection with the use of the nasal douche, that many 
specialists have condemned it altogether as too dangerous 
for. common use. If the directions given are carefully ob- 
served, however, it may be used without danger. Nos. 
1-4, use four ounces for each pint of solution. 



The Local Treatment of Chronic Nasal Catarrh. 75 



Fourth Method. — The post-nasal douche is another 
method which cleanses the nasal cavities in a more effect- 
ive manner than any one of the methods before given, 
and hence is especially adapted to those cases of catarrh 
in which there is a very troublesome dropping at the back 
of the throat. For administering- the post-nasal douche, a 
tube shaped something like the italic letter f is required. 

(Fig. 2.) The upper end 
of the tube must be passed 
into the mouth, to the back 

FIG. 2. — POST-NASAL DOUCHE- ° f the throat ' then upward 

behind the uvula, or soft 

palate. The head should 

be inclined forward, so that the injected fluid may flow out 

through the nose with ease. The reservoir should be held 

a short distance above the head, so that the water will 

not flow with too great force. 

C3 



1 



TUBE. 



The same care must be ob- 
served respecting swallow- 
ing, as there is some danger 
of forcing water into the Eu- 
stachian tubes, by this meth- 
od as well as by the preced- 
ing one. One of the best 
forms of syringes for admin- 
istering both the nasal and 
post-nasal douches, is that 
known as the syphon syr- 
inge, which is shown in Fig. 
3. Use of Nos. 1-4, four 
ounces to each pint of so- 
lution. 

Fifth Method. — Another 
very effective method for 
cleansing the nasal cavity, 

is the use of the air atomizer. (Fig. 6§- The atomizer 
produces a coarse spray with considerable force, and is 
best for this purpose. The spray should be directed into 




FIG. 



SYPHON SYRINGE. 



y6 Eighth Lecture. 

each nostril in various directions, to insure cleansing of 
the entire surface, and in cases requiring- it, may be di- 
rected behind the soft palate, thus cleansing the back part 
of the nasal cavity also. Use Nos. I, 2, j. 

Sixth Method. — There is still another method of cleans- 
ing the nasal cavity, which, although somewhat difficult 
of execution, may be easily acquired by most persons, and 
is especially effective in cleansing the back part of the 
cavity. This method consists simply in gargling the cleans- 
ing solution in the throat, and throwing the liquid for- 
ward, expelling it through the nose. This cannot be done 




FIG. 4. — THE AIR ATOMIZER. 

in the ordinary method of gargling liquids in the throat, 
which is, in fact, of little value, even for the application 
of medicaments to the throat, as the solution is held too 
far forward in the cavity of the mouth to be of any great 
service to the diseased tissues. Gargling should be exe- 
cuted in this manner : Taking a proper quantity of fluid 
into the mouth, throw the head back as far as possible. 
When the head is held in this position, it is impossible to 
swallow, as the esophagus is compressed so firmly between 
the larynx and the spinal column that nothing can pass 
downward through it. The liquid should be allowed to 
pass back as far as possible in the throat, as though it 
were to be swallowed ; then, when an attempt is made to 



The Local Treatment of Chronic Nasal Catarrh. Jj 

swallow, it will be thrown into the nasal cavity, and if the 
head is thrown upward at just the right moment, the fluid 
may be ejected through the nostrils. Use Nos. I, 2, 3, 4, 
one part to three parts of hot water. 

Of the various cleansing methods which we have men- 
tioned, the most efficient for general use are the sponge 
nasal douche and the cleansing spray. An atomizer, prop- 
erly adapted to this purpose, will produce a strong and 
coarse spray. 

Medicated Solutions, Vapors, etc. — Having cleansed the 
nasal cavity thoroughly, a medicated solution may be ap- 
plied, for the purpose of relieving the chronic congestion 
of the membrane, and inducing a more healthy action. In 
cases of simple catarrh, however, the thorough application 
of the cleansing solution alone is often sufficient to effect, 
in time, an entire cure. 

Medicated solutions may be applied by any one of the 
methods above described, but the air atomizer is the best, as 
it thoroughly distributes the solution over the entire dis- 
eased surface. The saturated sponge is perhaps the next 
best method for applying these solutions. When the sponge 
is used, the solution should be of only one eighth the 
strength used with the atomizer. A sufficient quantity 
should be used to reach the desired portions. From half 
an ounce to an ounce will usually accomplish this, when 
the atomizer is employed. 

Excellent formulas for a variety of cleansing astringents 
and other remedies, are given in the concluding • chapter 
of this work. 

It must not be understood that any one remedy is a 
proper application for all cases of catarrh. When the sec- 
ond stage of the disease is merging into the third, and 
also when the latter stage has been reached, astringent 
remedies, even though giving temporary relief, are exceed- 
ingly harmful, and should never be employed. In these 
cases, disinfectant and stimulating lotions, powders, and 
inhalants, are to be employed. Among the best remedies for 
this purpose, are menthol, camphor, benzoin, and the oils 



78 



Eight Ji Lectiire. 




FIG. 5. 



-THE STEAM IN- 
HALER. 

this remedy, 
This may be done 



of eucalyptus, cubebs, sandal- 
wood, and Scotch pine. In the 
use of these and similar remedies, 
the steam inhaler ( Fig. 7) and 
the balsam bottle (Fig. 8) are in- 
dispensable. Formulas for the 
remedies of this class which we 
have found most valuable, are 
given in the closing chapter. 

A remedy which may be used 
with advantage in nearly all cases 
of nasal catarrh, is chloride of 
ammonia. The proper way in which to use 
is to charge the air of a room with it 
by placing a cup containing a little strong hydrochloric 
acid into a large bowl containing strong aqua ammonia, as 
directed in No. 46. If * hydrochloric or 
muriatic acid cannot be procured, a table- 
spoonful of salt may be placed in the 
small cup, and a teaspoonful of sulphuric 
acid added once or twice a day. By ad- 
ding acid to the small cup, and ammonia 
to the large one, occasionally, the fumes 
of ammonia chloride will be formed con- 
stantly. 

By means of a paper cone, or a paste- 
board or rubber tube, the fumes may be 
inhaled directly. When used in this way, 
FIG. 6. — BALSAM care should be taken to avoid the inha- 




BOTTLE. 



lation of strong ammonia or acid fumes. 



NINTH LECTURE. 



£lje treatment of Special iforms of Nasal (ilatarrl). 



Let us now consider the special methods to be adopted 
in the treatment of the principal forms of nasal catarrh, 
and in the various conditions which result from it, and 
which require special measures for their relief. 

Simple Chronic Nasal Catarrh. — This is by far 

the most common of all forms of nasal catarrh. It is 
chiefly characterized by the thick, yellow discharge which 
necessitates frequent use of the handkerchief, or clear- 
ing from the throat of the thick mucous discharges which 
are constantly dropping into it from the back part of the 
nasal cavity. Either or both of these prominent symptoms 
may be present, according as the disease is chiefly located 
in the anterior or posterior part of the nasal cavity, or 
throughout the whole extent of the nasal mucous mem- 
brane. Other symptoms of this form of the disease which 
we have previously described, we do not need to recapitu- 
late. The examination of the nasal mucous membrane by 
means of instruments for the purpose, shows the affected 
portion to be red and swollen with congestion, and cov- 
ered more or less with mucus. 

After thorough cleansing of the nasal cavity with Nos. 
I, 2, j, or 4, apply, by means ot a hand atomizer, from 
one half an ounce to an ounce of either of the following 
solutions, the relative values of which are indicated by the 
order in which they are named, although the effects differ 
in different persons, and a change is advantageous oc- 
casionally in most cases : Nos. io y 24., 20, 18, 19, 21, 22, 

2J, 29, JO, JI, 28, '26. 

(79) 



80 Ninth Lecture. 

This treatment should be applied twice daily. It is best 
taken before breakfast, and a short time before retiring at 
night. Care should be taken to avoid breathing very cold 
air immediately after taking the treatment. 

After continuing this treatment for two or three weeks,, 
it may be suspended for a few clays or a week, and then 
renewed. It is sometimes necessary to continue the treat- 
ment for a year or two, making such changes in remedies 
as may be necessary to control the symptoms. 

Electricity. — This agent, especially in the form of 
galvanism, has an established value in the treatment of 
this form of catarrh. It is important that the positive 
electrode should be applied to the affected surfaces. By 
means of a proper electrode, the specialist is able to ac- 
complish much with this wonderful agent. We have lately 
devised a simple form of battery for use in these cases,, 
which we believe will be found very serviceable. 

Dry Catarrh.. — This form of the disease usually fol- 
lows the preceding, and is a natural result of the inflam- 
matory condition to which the mucous membrane has been 
so long subjected. The employment of astringents in this 
form of catarrh, is exceedingly harmful, as the secretions 
are already too scanty, and astringent remedies will only 
serve to render them still more deficient. Patients of this 
class are often greatly injured by the popular catarrh 
snuffs and other remedies which have been so widely ad- 
vertised. The remedies required at this stage of the dis- 
ease, are such as will cleanse and disinfect the nasal cav- 
ity, stimulate secretion moderately, and protect eroded 
surfaces. For the first two purposes named, the following 
prescriptions will be found of excellent service : For 
cleansing solutions, Nos. J and 4. To follow cleansing 
solution, Nos. 7, 10, 11, 12^13, 14, 75, 16, 17, 6, 5, 8, p. 
Of course, but one of these should be used at a time, 
though it is well to change the solution occasionally. 

In cases in which there is great dryness of the nostrils, 



The Treatment of Special Forms of Nasal Catarrh. 8 1 

oil of petrolina, fluid vaseline, or cosmoline should be em- 
ployed. Vaseline can be used with an atomizer, if kept 
hot while the application is made ; but this requires a 
special form of atomizer. It may be warmed, and applied 
with a bit of cotton rolled about the end of a toothpick- 
If applied to the nostrils freely, it will melt and find its 
way into the various parts of the nasal cavity, if a supine 
position is maintained for an hour or so after the ap- 
plication is made. On this account, it is well to apply/ 
the vaseline at night, just before retiring. Oil of petrolina,. 
fluid vaseline, or cosmoline may be used with an ordinary 
atomizer. In the absence of any of these remedies, cacao 
butter may be molded or whittled into pencils, one of 
which may be introduced into each nostril upon retiring. 

In cases in which an unpleasant dryness of the nasal 
cavity is occasioned by too great size of the passages, as 
is frequently found in the advanced stage of this form of 
catarrh, a small pledget of cotton should be introduced 
into one or both nostrils on rising in the morning and 
on retiring at night. 

While I do not commonly employ powders in the 
treatment of this disease, and would especially condemn 
the numerous catarrh snuffs so widely advertised in the 
newspapers, I have obtained good results by the use of a 
few preparations of this sort, and would especially recom- 
mend Nos. 26, 27, 28, for this form of catarrh. Powders 
may be used with a powder blower or insufflator, or as a. 
snuff, a pinch being taken several times daily. 

Offensive Catarrh. — Bad Breath. —The three 

principal causes of bad breath are, (1.) An unwholesome 
condition of the mouth, decaying cavities in the teeth,, 
decomposing portions of food lodged between the teeth, 
etc. ; (2.) Dyspepsia, producing foul tongue, and decom- 
position through the action of germs ; (3.) Decomposing 
secretions in the nasal cavity. The last is perhaps one 
of the most common of all causes of bad breath. This 
condition may exist in either the second or the third 



82 Ninth Lecture. 

stage of the disease. In the second stage, obstructions 
to the discharge of the superabundant secretion may oc- 
casion decomposition through long retention, and thus 
render the breath offensive. As the second stage grad- 
ually changes to the third form of the disease, the secre- 
tion becomes less abundant, and, in consequence, plugs of 
dry mucus obstruct the nasal passages, and undergoing de- 
composition, give out most offensive odors. 

In the third stage of the disease, or dry catarrh, the se- 
cretion is so scanty that it is not freely discharged, and 
adhering to the surface, undergoes decomposition and gives 
rise to a fetor in the breath which is sometimes most dis- 
gusting. The ulcerations of the mucous membrane, which 
occur in this form of the disease, with the accompanying 
pus and blood, through the decomposition of the mem- 
brane, increase the offensiveness of the breath. 

This form of the disease, is best treated by thorough 
cleansing of the nasal cavity daily, and if necessary, two 
or three times a day. For this purpose, the remedies which 
our experience has shown to be most satisfactory, are Nos. 
6, 7, 10. In these cases, especially those in which plugs 
of mucus are formed, the only satisfactory method of cleans- 
ing the nasal cavity is by the sponge nasal douche or the 
post-nasal douche. This should be used with great thor- 
oughness. In case the accumulations are chiefly in the 
front part of the nose, the ordinary form of nasal douche, 
taken with .the syphon syringe, will answer the purpose 
very well, although even in these cases the sponge is to 
be preferred. 

Disinfecting solutions must follow the cleansing of the 
nasal cavity, and must be thoroughly applied. The follow- 
ing perhaps represent the best prescriptions to be employed 
for this purpose : Nos. 11, 12, ij, 15, 14, 43, 44, 45, 48, 
49> SO- 

Coryza. — This is the term applied to that condition in 
which there is a watery discharge from the nose, requir- 
ing the almost constant use of the handkerchief. This 



The Treatment of Special Forms of Nasal Catarrh. 83 

symptom occurs most frequently in cases of acute catarrh, 
or when a cold has just been contracted. In some cases, 
however, the condition is chronic. If there is not a con- 
stant discharge from the nose, the slightest draught will 
excite it. In some cases, the discharge will be aggravated 
by eating, making it necessary for the patient to resort to 
the handkerchief almost immediately upon beginning a 
meal, occasioning very great annoyance. Among the best 
remedies for local application, will be found Nos. 33, 34, 
35, 28. 

The application of galvanism to the back of the neck, 
and to the face in the region of the nose, I have also 
found of great service. Bathing the face with hot water, 
or the application of a hot spray to the face, is useful 
in these cases. A warm foot or leg bath, by means of which 
the blood is withdrawn from the upper part of the body, 
is also useful. 

Nasal Voice. — The obstruction arising from thicken- 
ing of the membranes lining the nasal cavity, gives rise 
to a nasal tone, audible or snoring respiration during sleep, 
and restlessness at night from the necessity for frequent 
turning from side to side to relieve the obstruction. In 
these cases, the obtruction is usually due to a hypertrophy, 
or overgrowth, of the mucous membrane covering the lower 
turbanated bones, situated just within the nostrils. When 
a person in whom this condition exists lies upon one side, 
the thickened tissues upon that side swell up so as to 
close the nostril. On turning upon the other side, relief 
is experienced for a time. Then the tissues of the other 
side begin swelling in the same way, and the breathing 
is again obstructed. This explains the well-known fact 
that a snorer may often be quieted by turning him over 
in bed. Many persons who are not suffering from a de- 
gree of obstruction sufficient to cause inconvenience when 
in an upright position, nevertheless suffer great annoyance 
from this cause during sleep, on account of the increased 
amount of blood in the head. 



84 Ninth Lecture. 

The annoying symptoms of this condition may often be 
palliated by the use of cleansing and astringent remedies, 
such as Nos. 3, 4, 6, 7, 10, u } 20, 23, 24, 25, 26, 27, 30, 
32, J7, 18, /<?, 21, 22. 

Still greater relief is often afforded by means of pencils, 
which may be introduced into the nostrils on retiring at 
night, or at other times when the obstruction occasions 
great distress. No. 36. 

A remedy which gives more prompt relief in these cases 
than any other, is a solution of cocaine. It should be used 
with an atomizer or a bit of cotton wound around the end 
of a tooth-pick. A four-per-cent solution is sufficiently 
strong for this purpose. Only a small quantity is required, 
simply enough to moisten the mucous membrane of the 
affected part. 

The menthol inhaler, consisting of a small tube contain- 
ing crystals of menthol, is a useful palliative remedy. The 
menthol stimulates the blood-vessels to contract, and thus 
affords relief. 

The obstructed nostril may be temporarily opened, and 
a partial cure effected, by means of dilators, small ones 
being used first, then larger ones as the obstruction is 
diminished in size. In cases of complete obstruction, tem- 
porary relief is afforded by the introduction of a tube into 
one or both nostrils. This not only compresses the swol- 
len membrane, but furnishes an opening through which the 
air may be admitted. 

I have devised a small battery for use in these cases, 
which may be attached to the breathing-tube or dilator, 
and thus convert the latter into an electrode, by which 
means its effect is greatly increased. 

The only radical measure of relief from this distressing 
condition, however, is the use of such means as will de- 
stroy the thickened tissue or a portion of it. It may 
sometimes be removed by the snare, as in the case of a 
polypus. More often, however, the skilled specialist em- 
ploys the galvano-cautery, by means of which small cic- 
atrices, or scars, may be made upon the growth. ' These, 



The Treatment of Special Forms of Nasal Catarrh. 85 

by their contraction, ultimately obliterate the growth, af- 
fording the sufferer permanent relief. 

Mouth-Breathing — Snoring. — This affection, for 

it may be properly called a disease, or at least a symp- 
tom of disease, is very common among persons suffering 
from catarrh. Its cause is partial obstruction of the nasal 
passages. Snoring respiration occurs during sleep, but not 
when obstruction of the nostrils is complete. This condi- 
tion is one which should receive prompt attention, whether 
present in an adult or a child. Children whose nasal cavi- 
ties are so obstructed as to occasion snoring or mouth- 
breathing, are likely to suffer life-long injury. The lungs 
are often seriously affected, and the entire breathing ap- 
paratus injured. The peculiar deformity known as "pigeon 
breast" is due to mouth-breathing. Serious facial deform- 
ity is also due to this abnormal method of breathing. The 
lower jaw falls backward and downward. The upper jaw 
becomes narrower, the teeth project, and the upper lip short- 
ens. The chin becomes retreating, the teeth are uncov- 
ered, and the upper teeth project beyond the lower, so that 
a deformity, sometimes most repulsive, is produced. 

Mouth-breathers are much more liable to all forms of 
disease affecting the air-passages, than are others. The 
important functions of the nose in relation to breathing, 
we have already studied. When the nose is obstructed, it 
not only loses its utility as an organ of respiration and 
the seat of the olfactory sense, but the disease of the nose 
is productive of disease of other parts. Mouth-breathers 
never have a " good wind," but are generally feeble and 
defective in many ways. The relation of mouth-breathing 
to deafness, is' also important. In ordinary respiration 
through the nose, the air is made to strike upon the 
mouths of the Eustachian tubes, which it enters, thus 
changing the air in the ears, one of the conditions es- 
sential to their health. Nasal obstruction prevents the 
proper ventilation of the ears, and thus becomes a cause 
of deafness. 



86 Ninth Lecture. 

Treatment. — The treatment of mouth-breathing requires, 
first of all, removal of obstructions from the nasal cavities. 
The various devices which have been contrived for ob- 
structing the mouth, simply deal with the result, and not 
with the cause, of the affection. Air must be received 
through some channel. If it cannot be obtained through 
the nostrils, it must be taken in through the mouth — bet- 
ter through this channel than not at all. The method of 
treating obstruction of the nostrils, we have already de- 
scribed. 

In some cases, mouth-breathing is simply a habitj ac- 
quired as the result of a cold, causing temporary nasal ob- 
struction. This habit is very often commenced in early 
infancy in this way. Sometimes it exists after the cause 
has been removed by the proper treatment of obstructions 
to nasal respiration. In these cases, relief may be obtained 
by such means as will keep the mouth closed during sleep. 
A cap made to fit snugly over the mouth and chin, at- 
tached to a night-cap by two tapes upon either side, one 
in front and the other behind the ear, serves a very use- 
ful purpose. Another method which possesses points of ad- 
vantage, is to wear a small plate made to fit the front teeth, 
reaching on either side to a point behind the angle of the 
mouth, and wide enough to be easily retained by the lips 
after it has been placed in position. Placing this properly 
in the mouth upon going to bed, it will be retained with- 
out difficulty. A stout cord should be attached, however, 
by which it can be easily withdrawn from the throat, in 
case of accidental swallowing during sleep — an accident 
not very likely to occur. Such a plate can be made by 
any dentist. They are also manufactured and sold for 
this purpose. It is important that these instruments should 
be made to fit the individual seeking relief. 

Cold Sores. — These annoying accompaniments of 
acute nasal catarrh, may generally be relieved, when they 
first make their appearance, by applying to each a drop 



The Treatment of Special Forms of Nasal Catarrh. 87 

of spirits of camphor. When well developed, a hot spray r 
followed by an application of zinc ointment, will give re- 
lief. Both the spray and the ointment should be applied 
two or three times a day. Collodion painted on the sore 
is also a good remedy. 

Nosebleed. — Nasal catarrh is one of the most com- 
mon causes of nosebleed. The congested condition of the 
nasal mucous membrane, renders the nose at all times 
ready to bleed if the congestion is slightly increased by 
running, or other severe exercise, or by violent coughing. 
In the third stage of the disease, numerous small ulcers 
and abrasions expose the blood-vessels, and the dislodge- 
ment of a scab or a mass of dried secretion, is all that is 
needed to occasion a hemorrhage. 

Treatment. — Slight bleeding is readily stopped by hold- 
ing the hands above the head. A hot solution of soda, 
two drains to the pint of water, snuffed up the nostrils, is 
a very effective remedy. No. 5/, applied with an air atom- 
izer, is also very useful. Often the bleeding point is just 
within the nostril, and may be checked by simply press- 
ing the side of the nose for a few moments. Hold the 
head erect, and do not bathe the nose with cold water. Heat 
applied to the back of the neck, is a good remedy, as is 
also bathing the face and hands with very hot water. An- 
other simple remedy for bleeding at the nose, is a vigor- 
ous motion of the jaws, as in the act of mastication. A 
piece of rubber should be placed in the mouth, and chewed 
hard. It is the motion of the jaws that stops the flow of 
blood. This remedy is easy of application, and will suc- 
ceed in cases where the bleeding vessels are small. Call 
a physician, if the bleeding is not promptly checked. 

The most severe hemorrhage may be stopped by plug- 
ging the nostrils. Plugging the nostrils is not so difficult 
an operation as might be imagined. It is only neces- 
sary to pass through the nose a stiff, waxed thread, or 
a piece of shoemaker's " waxed-end ; " catch the end in 
the throat, draw it out through the mouth, and attach a 



88 Ninth Lecture. 

piece of cotton, rolled firmly, about the size of a walnut, 
and draw it tightly into position. Sometimes both sides 
must be plugged. It is important to leave an end hang- 
ing down from the mass of cotton in the throat, which 
may be seized by a pair of forceps, and used to withdraw 
the cotton after the bleeding is stopped. The cotton 
should be left in place for twenty-four hours. 

Urinary Deposits. — Whitish, reddish, pinkish, and 
brick-dust sediments are very frequent in these cases. 
The discharge of nasal catarrh is unquestionably to some 
degree a vicarious excretion ; that is, the mucous mem- 
brane of the nose is trying to do for the liver the work 
which the latter fails to accomplish. Colesterine, the poi- 
sonous matter carried off by the liver, has been found in 
considerable quantities in the dry plugs which frequently 
obstruct the air-passages, in persons suffering from this dis- 
ease. Catarrhal patients should observe if there are deposits 
in the urine, and give the matter careful attention. Deposits 
of a reddish color or brick-dust character, indicate an in- 
active liver. The best remedy in this condition is copious 
water-drinking. Hot water should be taken in quantities 
of two to four pints daily. One to three glasses may be 
taken half an hour or an hour before each meal. Lung 
gymnastics should be practiced daily, as by the acceler- 
ated movements of the diaphragm, the action of the liver 
is greatly aided. The increased quantity of oxygen taken 
in, also helps the liver about its work. I have found great 
advantage in obstinate cases of this sort, from the use of 
oxygen by enema, a method of treatment which I had the 
honor to bring before the profession a year or two ago. 

Constipation. — This condition is so commonly pres- 
ent in cases of catarrh, that it should receive at least 
brief attention in this connection. It doubtless arises in 
most cases from an inactive state of the liver, the secre- 



The Treatment of Special Forms of Nasal Catarrh. 89 

tion of which is a stimulant to the muscular action of the 
intestines, — a sort of natural laxative. 

Most cases of this disorder may be relieved by atten- 
tion to the following simple measures : — 

On going to bed at night, wrap about the body a coarse 
towel moistened with cold water, covering with enough 
thicknesses of dry flannel to keep warm. On rising in the 
morning, dip the hands in cold water, rub the body 
briskly, and dry with a rough towel. Knead the bowels 
thoroughly for five minutes. Eat an orange or an apple 
before breakfast. Make the diet consist chiefly of fruits, 
grains, vegetables, milk, and cream ; take little meat and 
no butter ; avoid condiments ; and use but little salt and 
sugar. Take four to ten glasses of water daily — one or 
two glasses of hot water before each meal is the best 
mode of taking. Persons who have good stomach diges- 
tion may, instead, take cold water before breakfast. Have 
a regular hour for relieving the bowels, and faithfully 
attend to this duty at that time. If the stool is not dry 
and hard, but the lower bowel seems to be lacking in 
power or in sensibility, as is often the case when the 
enema has been long employed, take an enema of cold 
water, a gill or a half pint at a time, to cause the bowels 
to act. A little salt or soap, a tablespoonful of glycer- 
ine, or a few drops of spirits of camphor may be added, 
if cold water alone is not sufficient. Discontinue by de- 
grees, as the bowels become more sensitive. 

Take abundance of out-door exercise, and protect the 
stomach and bowels by an extra layer of warm flannel, 
worn around the body. In kneading the bowels, it is well 
to use a little oil, to lubricate the surface. 

Headache. — One of the most prominent features of 
chronic catarrh, is headache of some form. The most 
common seat of this symptom is the lower portion of the 
forehead, just above the brows, often extending down to 
the bridge of the nose. In catarrhal headaches, the pain 
is usually continual, rarely sharp or severe, but distressing 



90 Ninth Lecture. 

on account of its constant presence. Not infrequently, the 
seat of pain is at the lower and back part of the head. 
Pain at the front part of the head, just above the brows, indi- 
cates an extension of the disease to the frontal sinuses ; 
and pain at the back part of the head, indicates an ex- 
tension of the disease to the cells in the sphenoid bone, 
at the base of the skull. One of the most frequent causes 
of this form of headache, is violent blowing- of the nose, 
which, as before remarked, should never be practised. 
Occasionally, the small openings which communicate be- 
tween the cavity referred to and the nasal cavity, become 
obstructed, giving rise to an accumulation of secretion. 
When this occurs, the most intense pain results, and a 
degree of inflammation, attended by fever and other dis- 
tressing symptoms, may follow. This form of headache is- 
often relieved by bathing the affected parts in hot water. 
Derivative treatment, as warm foot, leg, or sitz baths, or 
a warm blanket pack, will frequently give great relief. Re- 
lief is often afforded also by the use of the menthol inhaler, 
No. 52, or the balsam bottle, No. 4.8 and Fig. 6. The 
application of menthol, in substance or as a liniment, over 
the painful part, usually gives relief. In cases of severe in- 
flammation, constant applications of hot poultices should 
be made, if found comfortable. If not, the ice-bag may be 
used a portion of the time. In some cases, greatest re- 
lief is given by the use of ice-bags most of the time, and 
hot applications at intervals of two or three hours. 

In obstinate cases of this sort, relief may often be af- 
forded by the use of the air-bag, shown in Fig. 9. By 
the forcible injection of air into the closed nasal cavity, 
an air-current is driven into the recesses of the nasal cavi- 
ty and its communicating chambers, and thus imprisoned 
secretions^are liberated, relieving the oppressive fullness, 
of which, the patient complains. The injected air may be 
charged with the vapor of acetic ether, with good effect. 

Persons subject to catarrhal headache, should carefully 
protect the forehead whenever obliged to go out in the 
cold, as the circulation of the skin overlying the affected- 



The Treatment of Special Forms of Nasal Catarrh. 91 

parts sustains such a relation to the diseased surfaces as 
to occasion mischief as the result of exposure to cold. It 
is well on this account to apply a little oil or vaseline to 
the face, forehead, and nose before going out of doors in 
cold winter weather, and to otherwise protect these parts. 

Faceache. — This is another of the distressing symp- 
toms often found present in catarrh. The pain is due to 
invasion of the hollow places of the facial bones by the 
disease. The nature of this condition, and the remedies 
required, are substantially the same as described in rela- 
tion to headache. One of the most convenient means of 
applying heat in these cases, is a rubber bag filled with hot 
water, though hot poultices or any other form of heat may 
be used. The air-bag is also of service in these cases. 

Suffocative Colds- — In this form of cold, the inflam- 
mation chiefly affects the back portion of the nasal cavity, 
and by causing enlargement of the pharyngeal tonsil, partly 
or completely closes up the posterior opening of the nose, 
so that the air can enter only through the mouth. The 
patient suffers great distress from a sensation of suffoca- 
tion which is constantly present, although he can breathe 
without difficulty through the mouth. The distress is ag- 
gravated by lying down, from the increased fullness in 
the blood-vessels of the head, induced by the recumbent 
position, and is relieved by sitting up. 

The patient should take a hot foot or si'tz bath, and 
have .hot applications made to the upper part of the spine, 
particularly to the back of the neck. A mustard fomen- 
tation or a mustard poultice, applied to the back of the 
neck, will sometimes give great relief. Gargling hot wa- 
ter in the throat, in the manner described as " sixth 
method," page 76, and the use of a hot solution of soda, 
a dram to the pint, by means of the sponge or nasal douche, 
will often give relief. Solution No. jj is also a most ef- 
fective remedy. It should be applied until the most dis- 
tressing symptoms are relieved. The swelling occasioned 



92 NintJi Lecture. 

by a cold of this sort, can often be made to disappear 
rapidly by the use of solution No. 37, following some form 
of cleansing spray. 

Snilfiles. — This form of catarrh, most common in 
young children, is generally due to the same causes as is 
suffocative catarrh in older persons. The symptoms are 
also much the same. The child seems to be distressed for 
breath. It tries to breathe through the nose, but without 
success. There is a constant running of the nose, and the 
child, even though of sufficient age, is not able to blow 
the nose, the passages from the nose to the throat being, 
in many of these cases, entirely closed. 

Treatment. — Cleansing and astringent sprays, applied to 
both the nostrils and the throat, are essential in this dis- 
ease. Nos. 3 and 4. are particularly serviceable as cleans- 
ing solutions, and Nos. 24, 26, 37, will be found most use- 
ful in lessening the secretion and the swelling of the 
diseased parts. Most of these cases require a surgical 
operation for the removal of the growths. An operation 
of this sort requires the skill of a specialist. 

Nasal PolypilS. — These growths, usually almost ge- 
latinous in consistency, are sometimes tough and fibrous in 
character. They develop in all parts of the nasal cavity, 
but chiefly in the upper portion and the sides. The symp- 
toms are obstruction of the nasal passages, nasal voice,- 
audible breathing, snoring during sleep, etc. They are usu- 
ally present in the second stage of catarrh. These growths 
often give rise not only to great annoyance, but to most 
distressing symptoms, as asthmatic paroxysms, and other 
nervous disturbances. 

Treatmejtt. — The old method of treating these growths 
was to seize them with a pair of forceps, and tear them 
away from their attachment. After treatment by this 
method, the growth speedily reappeared, often more vig- 
orous than before. It was not infrequently the case that 
a large strip of mucous membrane, as well as the growth 



The Treatment of Special Forms of Nasal Catarrh, 



93 



itself, was removed. The proper method of treating poly- 
pus is removal by the polypus snare, and treatment by the 
galvano-cautery. This, of course, requires the skill of the 
'specialist. 

Treatment of the nasal catarrh to which the polypi are due, 
is also necessary. This calls for the use of cleansing, and 
usually mildly astringent agents. Nos. I, 2, 3, 4, for cleans- 
ing purposes, and 21, 22, 23, 37, 23, 29, 31, as astrin- 
gents, are appropriate remedies. Polypi may sometimes be 
cured by the application of strong astringents, as pure tan- 
nic acid, applied in form of a powder, blown in through a 
tube. Astringents act by shriveling up the polypus, but of- 
ten fail, and produce so much irritation that their use is 
to be avoided when possible. In a case under my obser- 
vation, an attack of diphtheria in the nose cured a poly- 
pus of many years' standing. 

I have in several cases found chronic asthma to be 
wholly dependent upon these growths in the nasal cavity, 
and have speedily and permanently cured the disease by 
their removal. Temporary relief is usually given by the 
use of Nos. 34, 28, 33, 36. 

The number of these growths sometimes found, is most 
astonishing. In one instance, I removed between thirty 
and forty polypi of different sizes from a single nasal 
cavity. 

Nasal Obstructions. — In the second stage of nasal 
catarrh, that in which polypi appear, other causes of ob- 
struction also appear, as enlargement of the nasal bones, 
causing flattening and broadening of the bridge of the nose. 
The vomer becomes elongated and curved to one side. 
Bony or cartilaginous growths often appear on the septum 
of the nose. The nose may be so completely obstructed by 
these growths, as to wholly interrupt nasal respiration. 
Cases of this sort can be relieved only by a skillful speci- 
alist. 



•94 Ninth Lecture. 

Ulceration Of the Septum. — Patients in whom 
the disease has reached the third stage, or the latter part 
of the second, are often troubled by the formation of an 
ulcer upon the septum, just within the nostrils. A small 
scab is formed, which gradually increases in size, and its 
removal is followed by bleeding. By and by, to the pa- 
tient's horror, he finds that the ulcer has extended through 
the entire septum. 

Treatment. — After cleansing the sore surface, touch with 
a camel's-hair brush, or a small swab of cotton, moistened 
with a solution of nitrate of silver, ten grains to the ounce 
of water. 

LOSS of Smell. — One of the most common results 
of chronic nasal catarrh, is impairment of smell, or entire 
loss of this sense. When this is due to accumulation of 
secretions, relief is readily obtained ; if due to partial or 
complete obstruction of the nostrils, in consequence of which 
air cannot be made to reach the upper part of the nasal 
cavity, where the olfactory nerves are distributed, the sense 
of smell may be restored by removing the obstructions. 
The most hopeless cases are those in which the parts con- 
taining the nerves of smell have been the seat of the de- 
velopment of polypi, by which the natural structures have 
been destroyed, and cases of dry catarrh, in which the 
natural structures of the mucous lining of the nose have very 
largely disappeared. The sense of smell was often de- 
stroyed in the treatment of polypi by the old method of 
tearing them out with forceps, when, not infrequently, large 
strips of mucous membrane were torn off with the morbid 
growths. In many cases, also, the sense of smell has been 
impaired by the use of improper remedies, especially the 
use of astringents and in cases of dry catarrh, or their too 
long use in cases in which they were at first appropriate. 

The best remedy in obstinate cases of this sort in which 
other means have failed, is electricity. Either the Fara- 
dic or the galvanic current may be used. This agent is 
best employed under the direction of a competent surgeon. 



TENTH LECTURE. 



^Diseases of ti)c &t)roat ? (Ege, ano ©ar, 5Due to Nasal OTa- 

tarrl). 



Acute Tonsilitis. — A very common affection in per- 
sons suffering from chronic nasal catarrh, is tonsilitis, or 
inflammation of the tonsils, which is well illustrated in 
Plate III. The inflammation may be either acute or 
chronic, and may involve simply the surface of the ton- 
sil, in which case it is known as follicular tonsilitis, 
or the entire tonsil may be inflamed. There is usually 
swelling of the gland in all cases. As the treatment to 
be employed is essentially the same in either class of 
cases, it is useless to define the exact differences between 
the various forms of tonsilitis, except to point out that 
the disease may be either acute or chronic. In the 
acute form, the most prominent symptoms are a 
chill or chilliness, backache, usually headache, soreness 
and aching of the flesh in all parts of the body, fever, 
and soreness of the throat. Sometimes the soreness of 
the throat is the last symptom to appear, so that there 
may be some uncertainty as to the nature of the disease. 
I have often found the tonsils much swollen, and the 
throat red and inflamed, when the patient declared that 
there was nothing whatever the matter with the throat. 
When the tonsils are much swollen, there is often great 
difficulty in swallowing, and great pain. The greatest 
distress is occasioned by the swelling of the uvula and 
soft palate, which not infrequently occurs. It is quite 
probable that this disease is contagious, and the fact that 
it may be easily confounded with diphtheria, renders it 
important that it should be treated as contagious ; 
that is, a person suffering from acute tonsilitis should 
be isolated, small children, in particular, being kept away 
from the patient, and the same precautions being taken 



g6 Tenth Lecture. 

as are necessary in cases of other contagious diseases. I 
have met very severe cases of diphtheria which originated 
in contagion from persons who were suffering from what 
was supposed to be only a mild attack of tonsilitis. 

Treatment. — The general pain and distress is best 
relieved by a hot bath or a hot-blanket pack. At the 
outset of the disease, ice-compresses or ice-bags should 
be applied to the throat constantly, with hot fomentations 
every two or three hours. The patient may be given 
small bits of ice to hold in the mouth and swallow, to 
control the local inflammation. The steam inhaler is of 
great service in these cases (Fig. 5). Steam alone is of 
great value as a remedy. No. 46 may also be used with 
benefit. The inhaler should be employed as long and as 
often as it is found comfortable. After the fever accom- 
panying the disease has subsided, Nos. 43 or 44 may be 
used, three or four times daily, with the inhaler. 

The patient should also be encouraged to drink water 
freely. Hot water is to be preferred to cold, and he 
should drink at least three or four pints during the 
course of the day. Great relief is afforded by the hot 
gargle, which should be taken every fifteen or twenty 
minutes, a half glass of water being used each time. The 
water should be as hot as can be borne. It is well to 
add to the water a little chlorate of potash, a dram to 
the pint of water; but this is not essential. 

The application, with a swab, of a solution of cocaine, 
No. 34, often gives great relief in these cases. I have 
also seen great relief from the use of a solution of nitrate 
of silver. No. 42. 

If suppuration of the tonsil occurs, it should be lanced 
as soon as the condition is indicated. Extreme swelling, 
accompanied by a throbbing pain, with great redness and 
tenderness of the tonsil, are indications of suppuration. 
It is, of course, necessary to' call a physician to attend 
the patient in cases of this sort. 




Acute Inflammation of the Larynx. 



I 




Chronic Inflammation of the Larynx. 



III. 



Diseases of the TJiroat, Etc., Due to Nasal Catarrh. 97 

Chronic Inflammation of the Tonsils — En- 
larged Tonsils. — Repeated inflammations of the ton- 
sils finally result in permanent enlargement of these glands. 
The appearance of the tonsils in this condition is well 
shown in Plate III. Usually little depressions will be ob- 
served in the tonsils. These are the enlarged and dilated 
follicles of the tonsils, which are the source of the small 
masses of foul-smelling cheesy matter frequently expelled 
from the throat by persons with enlarged tonsils. These 
cheesy particles are often mistaken for tubercles. 

The mischiefs which arise from enlarged tonsils are- 
very great ; and what is most unfortunate, the general 
public are not aware of this fact. Aside from the injury 
to the voice, the presence of these glands in the throat 
is often the cause of deafness, by producing disease ia 
the middle ear. The frequent inflammations which are 
set up by the slightest exposure to cold, are a constant 
menace, and a serious detriment to the general health. 

Treatment. — The only radical measure of treatment 
is removal, by 'a competent surgeon. Unfortunately, 
there is so great a prejudice against this perfectly harm- 
less procedure, that it is often neglected. It is claimed that 
the removal of the tonsils injures the voice, is likely to 
cause the disease to go to the lungs, prevents proper 
sexual development, causes consumption, and produces 
no end of mischief, — all of which is totally at variance 
with the facts of experience. I have . removed not less 
than half a bushel of tonsils, and have never seen other 
than the most desirable results. The only danger is from 
hemorrhage, and this is not a serious danger, only when 
the operation is done by inexperienced and incompetent 
persons. There is no longer any question among well- 
informed physicians, as to the advisability of removal of 
the tonsils in cases requiring the operation. It is possi- 
ble to remove the tonsils without a surgical procedure, in- 
cases in which the patient will not allow the operation to> 
be done, although an operation is much to be preferred 
as a means of getting rid of these annoying growths., 

G. 



98 Tenth Lecture. 

Astringent preparations applied once or twice a day, are 
also of service, as are applications to the tonsils of the 
galvano-cautery ; but the latter can only be made by a 
skillful surgeon. 

The question is sometimes asked, "If the tonsils can be 
removed without injury, why were they made." I reply, 
The question is not concerning the removal of healthy ton- 
sils, but diseased ones. A healthy tonsil is of service. It 
secretes a fluid which is able to convert starch into sugar, 
and so is an important aid to digestion. It is said, in- 
deed, that the secretion of the tonsils is even more pow- 
erful than that produced by the salivary glands, in digest- 
ing starch ; but a diseased tonsil, one which is enlarged 
and hardened, is no longer of service for this purpose. It 
is merely a mischievous obstruction, and should be re- 
moved ; and the sooner this is done, the better for the 
patient. 

Acilte Sore Throat. — This disease, properly termed 
acute pharyngitis, is often confounded with tonsilitis, which 
it usually accompanies, although it often occurs alone. 
The appearance of this disease is well illustrated in the 
colored cut at the top of Plate IV. The mucous mem- 
brane is everywhere swollen and red, and will be seen to 
to be covered with a tenacious mucus. 

Treatment. — The treatment of this condition is essen- 
tially the same as that which has been recommended for 
tonsilitis. It is also important in this disease, as well as 
in tonsilitis, to remember that it may readily be con- 
founded with diphtheria. On this account, the patient 
should be kept away from others, particularly small chil- 
dren. For treatment, see page 97, under head of treat- 
ment for tonsilitis. Nos. 34, 42. The inhalation of steam 
with the steam inhaler is also of great service, as in cases 
of acute tonsilitis. 

Diseases of the Larynx.— Among the most com- 

■•mon results of chronic nasal catarrh, is disease of the 




The Larynx, Vocal Cords Closed. 




The Larynx, Vocal Cords Open. 



II. 



Diseases of the TJiroat, Etc., Due to Nasal Catarrh. 99 

throat. The experience of specialists in the treatment of 
diseases of the nose and the throat, has led to the gen- 
eral conclusion that in the majority of cases catarrh of the 
throat has its origin in the nose, and is propagated down- 
ward by means of the discharges from the nasal cavity, 
which naturally find their way in this direction. It is 
evident, then, that in the treatment of this class of dis- 
orders, the place to begin is the nasal cavity. Remedies 
applied to the throat will prove of little value unless the 
disease of the nasal cavity is successfully treated. Hence 
it should be understood in reference to the treatment of 
the several diseased conditions of the throat of which we 
have spoken, that the nasal cavity is to be treated as well, 
according to the indications which may be present in each 
individual case. 

Hoarseness. — This common accompaniment of a cold 
is due to thickening of the vocal cords. If the swell- 
ing of the vocal cords is but slight, the voice may be only 
husky, as is common when a person has contracted a slight 
cold. A great amount of swelling produces hoarseness 
with inability to utter high-pitched sounds. A very great 
amount of swelling may occasion entire loss of voice. The 
condition of the larynx in cases of this sort may be seen 
in the upper figure shown on Plate II. 

Sometimes this condition becomes chronic, the voice is 
permanently impaired, weak, uncertain, husky, or otherwise 
changed in quality. This form of throat disease is often 
found in beer-drinkers, auctioneers, and clergymen who " in- 
tone" in speaking. In this condition, there is permanent 
thickening of the vocal cords and the cartilages of the 
larynx, an extreme case of which is illustrated in Plate II. 

Treatment. — For acute inflammation of the larynx, 
the chief requisite is rest of the voice, which in severe 
cases should be absolute, the patient not trying to speak 
above a whisper. The steam inhaler should be used at 
least every two or three hours, and such other measures 
should be adopted as have been recommended for the 



ioo Tenth Lecture. 

treatment of an acute cold, page 59. A solution of com- 
mon salt, carbonate of soda, or chlorate of potash, one 
dram to a pint of water of either one of the substances 
mentioned, may be advantageously used with the steam 
atomizer. One half ounce to an ounce may be used with 
the atomizer every two or three hours. A moist pack 
should be worn about the throat night and day, well 
covered, to prevent chilling. Fomentations about the 
throat and neck may also be applied with advantage two 
or three times daily. Mustard fomentations may be used 
if hot water does not give relief. 

The chronic form of this disease requires attention to 
all the general preventive and curative measures recom- 
mended for nasal catarrh. Especial attention must be 
given to the clothing. The disease is probably not wholly 
curable, though great improvement may be secured in 
most cases. 

Relief of the nasal catarrh which usually accompanies 
the disease is the most effective of all means of cure. 

In very chronic cases, a cold pack applied at night 
should be employed habitually, and as follows : Out of 
cold water, wring sufficiently dry so that it will not drip, 
a towel long enough to reach twice around the neck. 
Cover with several thicknesses of flannel, so as to keep 
warm during the night. Remove in the morning, rub the 
neck thoroughly with the hand dipped in water contain- 
ing salt, a tablespoonful to the quart, or with alcohol or 
distilled extract of witch-hazel. Afterwards, apply a little 
oil or vaseline, and wrap about the neck one or two 
thicknesses of flannel to be worn during tlie day through 
cold weather. Nos. io f 11, 18, ip, 20, are also of service 
in cases of this sort, used with the steam atomizer. 

Catarrhal Coilgh. — One of the most annoying symp- 
toms of this disease, especially when it has extended to 
the throat, is a throat cough. A cough does not always 
indicate disease of the throat, much less disease of the 
lungs, though most frequently it is due to chronic disease 



Diseases of the Throat, Etc., Due to Nasal Catarrh. 101 

of the tissues o{ the throat, follicular hypertrophy, elonga- 
tion of the palate, enlarged tonsils, dryness, or some other 
morbid condition. In not a few instances, it is merely a 
habit. A slight tickling in the throat sets up the dispo- 
sition to cough, which being yielded to, increases the irri- 
tation, and produces more coughing ; and thus the symptom 
is perpetuated. 

Treatment . — The various cough mixtures advertized in 
the newspapers, should be most studiously avoided. Most 
of these compounds contain opium, which is a most per- 
nicious drug in these cases, as it not only does not cure 
the cough, nor relieve it, except very temporarily, but 
aggravates the disease. Internal remedies of all sorts, that 
is, those that must be swallowed, should be avoided. The 
disease, so far as the cough is concerned, is local in char- 
acter, and should receive local treatment. It is a very un- 
wise thing to swallow a powerful drug, or such unwhole- 
some mixtures as sirup and whisky, which are often recom- 
mended in these cases, and send the medicine the whole 
length of the alimentary canal, and throughout the whole 
system, simply to secure its contact with the mucous mem- 
brane of the throat for a few seconds during its passage. 

The remedies elsewhere recommended for disease of 
the throat, are all excellent for use in the treatment of 
throat coughs, each being applied in conditions to which 
it is applicable, and which we need not here recapitulate. 
Simply drinking a glass of hot water, or gargling half a 
glass of water hot as can be borne, will often relieve a 
cough in a most magical manner. When there is dry- 
ness of the throat, a bit of licorice, or of any sapid sub- 
stance which will cause a flow of saliva and hence moisten 
the mucous membrane, will give relief. For a cough re- 
sulting from a hard cold in which the lungs are involved, 
a fomentation applied to the chest is a very effective meas- 
jre of treatment. A little mustard added to the water 
will increase the effect of the fomentation. Mouth-breath- 
ing is a frequent cause of throat cough, and must of course 
be corrected before the cough can be permanently relieved. 



102 - Tenth Lecture. 

When expectoration is copious, no remedy should be used 
to stop the cough, as it is necessary to remove the mor- 
bid secretion. If internal remedies must be used, as in 
cases of dry, harsh, irritable cough, we recommend the fol- 
lowing - as effective, and not likely to do harm, as do the 
common cough mixtures which contain opium or some 
other narcotic : Nos. 61, 62, 63. 

Chronic Sore Throat. — There are two forms of 
this disease, or more properly, two stages, which are shown 
in the colored engravings at the bottom of Plate IV. and 
the top of Plate V. The proper name of the disease is 
chronic pharyngitis. It is sometimes called "clergyman's 
sore throat." In the first stage of the disease, there is general 
thickening of the tissues of the throat. The uvula is often 
enlarged and elongated. There is much secretion, and 
the patient complains of a wooden feeling in the throat, 
a stiffness of the muscles of the throat, weakness and lack 
of flexibility of the voice. In speaking, the throat becomes 
tired soon, and there is a constant and most unpleasant 
hawking, hemming, spitting, and other efforts to clear the 
voice. 

In the more advanced stage of the disease, some of these 
symptoms are relieved. There is no swelling, the secre- 
tion is less in quantity, though more tenacious, but there 
is a most uncomfortable dryness, which is only very tem- 
porarily relieved by swallowing water or other fluids. On 
looking into the throat, it will be noticed that the unnat- 
ural swelling and redness have given place to the very op- 
posite conditions. There is an unnatural paleness of the 
mucous membrane. In some cases, it is almost white, 
either over the entire surface, or in patches. The uvula 
is often thinned, shortened, and pointed. The mucous mem- 
brane is sometimes so thin as to be almost transparent, 
and one can readily see the bony surfaces beneath. Here 
and there will be seen a red patch, or an enlarged follicle, 
which is frequently covered with a very tenacious mucus. 



Jill!!! 




Acute Pharyngitis. 




Chronic Pharyngitis. 



V. 



Diseases of the Throat, Etc., Due to Nasal Catarrh. 



TO 



The patient complains of a constant itching, or other dis- 
agreeable sensations. 

Treatment \- — -The two forms of this disease require 
very different treatment. When there is redness, swelling, 
and much secretion, astringent applications should be made 
twice daily, by means of a swab. Nos. 38, 39, 40, 47, 
are to- be most highly recommended for this purpose. The 
use of the steam inhaler, two or three times daily, the 
temperature of the steam being made as high as can be 
borne, is also of advantage. Nos. 4.3, 4.4., may be used 
with the inhaler. Gargle a pint of hot water in the throat 
several times daily. Treat the nasal cavity for any exist- 
ing catarrh, giving special attention to the back part of the 
nose, which is usually most affected in these cases. The 
balsam bottle, No. 48, may also be used with advantage, 
several times a day. 

The constant complaint of persons suffering from this 
disease, is the great susceptibility to taking cold on very 
slight exposure. An excellent means of overcoming this 
susceptibility, to some degree at least, is the daily applica- 
tion to the throat of the fumes of ammonium chloride. 
No. 4-7- 

The diet in this disease, is a matter of great importance- 
Tea, coffee, beer, and all narcotic drinks, condiments, ice- 
cream, ice-water, and all unwholesome and irritating foods, 
must be avoided. This form of sore throat is very com- 
mon among users of tobacco, It is quite impossible for a 
cure to be effected without a complete renunciation of the 
weed. Chronic pharyngitis is a common accompaniment 
of dyspepsia. In such cases, it is of course essential that 
the stomach disorders should be cured. 

The advanced stage of chronic pharyngitis requires very 
different treatment from that of the earlier stage of the 
disease. The general hygiene, as relates to food, clothing, 
etc., is the same, but in the use of local remedies, astringents 
should be carefully avoided. Applications which we have 
found of great service in cases of this sort, are Nos. 4i y 
42, 46, 48, 4p, 30. In the majority of cases, the disease 



104 Tenth Lecture. 

cannot be wholly cured. The condition of the mucous 
membrane of the throat is one in which the glands have 
disappeared by degeneration. The normal tissues are de- 
stroyed, and cannot be reproduced. 

In both forms of chronic sore throat, there is often a 
disagreeable tickling of the throat, due to an elongation 
of the uvula. In the early form of the disease, the 
swollen uvula will often contract under the use % of 
astringents. In some cases, especially of the later stage 
of the disease, the uvula is not only swollen, but over- 
grown, and relief can only be obtained by clipping off 
the redundant portion. The whole uvula should not be 
removed, as is sometimes done, as this organ is necessary 
to the perfect exercise of the voice. An operation of this 
sort should in all cases be performed by a competent sur- 
geon. By the application of a four-per-cent solution of 
cocaine, in the form of a spray, the operation can be done 
without pain. Bleeding, if troublesome, may be readily 
checked by gargling hot water, or by applying a solution 
of cocaine. 

False Or Spasmodic Croup.— This disease some- 
what resembles true croup in many points, and is often 
mistaken for it. Its chief points of difference are, little or 
no fever, spasmodic difficulty in breathing, with intervals 
of entire relief from the croupy symptoms, sudden appear- 
ance of the affection, usually at night, and as sudden dis- 
appearance. It generally begins with a cold. 

Treatment. — Hot and cold applications or fomentations 
to the throat, and hot and cold applications to the upper 
part of the spine. A sponge wrung out of hot water is a 
ready means of fomenting the throat. In the absence of 
hot water, the moist sponge may be heated by placing it 
upon a hot stove. An emetic of salt water, or a half tea- 
spoonful of powdered alum given in syrup or honey will 
often aid in cutting short an attack. 




< »Ji » ' 



Chronic Pharyngitis, Advanced Stage. 







Diphtheria. 



VI 



Diseases of the Throat, Etc., Due to Nasal Catarrh. 105 

Diphtheria. — I shall not undertake to describe this 
disease, nor to dwell at length upon its treatment, as 
it is a malady which always requires the supervision 
of an intelligent physician. In the treatment of cases of 
acute sore throat, whether the case is one of acute phar- 
yngitis or of tonsilitis, the possibility of the development 
of diphtheria in a severe form should always be consid- 
ered ; and whenever there is the slightest ground for sus- 
picion that the dread disease is present, thorough precau- 
tions should be taken to prevent its spread. The general 
treatment of the disease should be essentially the same as 
that recommended for acute tonsilitis ; in addition, how- 
ever, germicides must be applied to the throat, as strong 
as possible without injury. One of the best remedies of 
this class is alcohol, which should be applied with absorb- 
ent cotton, used as a swab. Chlorinated soda, one part to 
three of water, is also an excellent remedy for use in the 
same way. The steam inhaler used for ten or fifteen min- 
utes every hour or two, is a useful measure of treatment. 
Recent experiments have shown that a solution of papa- 
yotin, applied with a brush, is a most effective means of re- 
moving the false membrane formed in this disease. No. 

54- 

One of the most distressing accompaniments of this 

disease, is paralysis of the throat, which frequently exists 
for some weeks after other symptoms have been recov- 
ered from. Paralysis also not infrequently appears in other 
parts of the body. This symptom, fortunately, usually 
disappears without treatment in the course of a few weeks. 
Recovery may be expedited by the proper employment 
of electricity. 

Hay-Fever. — My observation has been that persons 
who suffer the most from hay-fever, are invariably those 
who suffer from catarrh, usually in a chronic form, during 
other seasons of the year, as a result of which the mucous 
membrane of the nose is in a swollen and thickened con- 
dition, obstructing the nasal passages to a greater or less 



io6 



Tenth Lecture. 



degree. A slight additional irritation, such as the cause 
of hay-fever creates, is sufficient to produce almost com- 
plete obstruction of the nose, and through reflex action, 
spasm of the air-tubes of the lungs is produced, making 
breathing difficult, and occasioning great distress. 

Experience with a large number of cases of this sort, has 
convinced me that hay-fever is a curable affection, notwith- 
standing the general belief to the contrary. There are al- 
ways to be found in these cases certain sensitive points 
in the nasal cavity, which may be treated by application's 
of the galvano-cautery, in such a manner as to overcome 
the hyper-sensitiveness which gives rise to the distressing 
symptoms of the disorder. 




FIG. 7. — THE EYE. 

n. The Nasal Duct, bv which the tears are carried to the nose. 



Disease of the Eye Due to Catarrh. — There is 

an important relation between diseases of the nasal cavity 
and of the eye, which ought not to be overlooked. A vio- 
lent cold is usually accompanied by redness of the eyes. 
This generally passes off in a few days or a few weeks. 
Sometimes, however, the inflammation becomes chronic. 
Many cases of chronic conjunctivitis have their origin in 
this way, and a large proportion of cases of nasal catarrh 
are accompanied by redness of the lids, granular lids, and 
other difficulties. A very annoying difficulty, which fre- 



Diseases of the Throat, Etc., Due to Nasal Catarrh. 1 07 

quently arises from nasal catarrh, is obstruction of the 
nasal duct (Fig. 7), in consequence of which the tears are 
not able to escape into the nose, and so run out over the 
lids and down the cheeks. In many cases, the duct is not 
entirely closed, so that the difficulty is not experienced ex- 
cept when the. patient is out of doors in the wind, or 
when the eyes are overtaxed, or otherwise irritated. 

Treatment. — The mild form of inflammation which 
attends an ordinary cold, requires no further treatment 
than simply bathing the eyes with hot water two or three 
times a day ; but when the inflammation is more severe, 
or does not readily pass away with the cold, some mildly 
astringent lotion may be used with advantage. A solution 
of boracic acid or borax, in proportion of two or three 
grains to an ounce of water, No, jp, is almost always of 
service, and in mild cases no other remedy is required. 
No. 60 is also useful. For more obstinate cases, employ 
Nos. 55, 56, 58. Lotions may be applied to the eye by 
means of a dropper, or with a bit of absorbent cotton 
twisted into a roll, or a strip of absorbent paper rolled into 
the form of a small tube. A few drops of a medicated so- 
lution are usually sufficient for an application. 

A solution of tannin, one dram to an ounce of glycerine, 
is effective in chronic cases in which there is much red- 
ness and thickening of the mucous membrane. Whenever 
the last-named remedy is used, it should be applied only 
to the everted lids, and the solution should be at once 
washed off with warm water. 

It is much better to consult a competent oculist in these 
cases, than to run the risk of harm to so delicate an or- 
gan as the eye, or to suffer injury from neglect to apply 
the proper remedy. 

Cases in which there is obstruction of the nasal duct, 
causing the tears to flow out over the lid, must be treated 
by a skillful oculist, as they often require a surgical op- 
eration, and great skill is necessary in their treatment. It 
is also important in these cases, as well as in cases of throat 
trouble dependent upon nasal catarrh, that the nasal cavity 



108 Tenth Lecture. 

should receive thorough treatment at the same time as 
the eye ; otherwise the disease is certain to return. 

Granular Lids. — One of the most common eye 
affections accompanying- chronic catarrh, is chronic gran- 
ular conjunctivitis, or' what is commonly known as gran- 
ular lids. The inner lining of the eyelid is red and 
roughened, and there is frequently a profuse secretion, 
which causes the lids to adhere together during sleep. 
The successful treatment of this condition requires : ( I ) 
The cure of the catarrhal condition of the nasal cavity, in 
which it probably originated ; ( 2 ) The daily application 
-of hot water to the eye in the form of a spray. This 
application should be made with thoroughness and with 
some force, and about as hot as can be borne. It should 
be made three times a day, and continued for about fif- 
teen minutes each time. By the employment of this 
remedy alone, I have relieved cases which for several years 
liad resisted all other methods of treatment. The cure 
may be expedited by the application of sulphate of cop- 
per, alum, and other astringents, to the lids. These rem- 
edies however, should be employed only by a competent 
physician. 

Diseases of the Ear, Resulting from Nasal 

Catarrh.. — Catarrh of the middle ear is the cause of 
at least nineteen-twentieths of all cases' of deafness. In 
the majority of cases, the catarrhal diseases begin in the 
nose and extend to the ear. The patient feels, at first, 
only an uncomfortable sensation in the ears or in the Eu- 
stachian tubes. (Fig. 8.) Perhaps he observes a peculiar 
sensation in the ears only when he swallows, especially 
just after a fresh cold has been contracted. Occasionally, 
ear ache is experienced. After a time, the discovery is 
made that there is very decided deafness in one or both 
ears. Perhaps there is a peculiar sound in the ears. It 
may be a chirping, as of a cricket or other insect. Often 



Diseases of the Throat, Etc., Due to Nasal Catarrh. 



ICKj 



the sound is a roar, as of the sea, or a beating or singing 
sound like the rumble of a train of cars. 

It is useless to treat these cases without giving atten- 
tion to the disease of the nasal cavity ; 
and when the disease has existed for 
some time, it is necessary that treatment 
should be applied directly to the ears as 
well as to the nose. One of the most 
effective means of treatment is inflation of 
the ears through the 




FIG. «.— THE EAR. 

Ear Drum ; 2. Eustachian Tube. 



nose. This may be 
done in three ways : 
The simplest method is 
that of Valsalva. The 
patient closes the nos- 
trils tightly with the 
thumb and finger so 
that no air can pass 
out, closes the mouth tightly, takes a long breath, and then 
blows as though trying to clear the nose, but keeping both 
nose and mouth tightly closed. The effect of this is to open 
up the Eustachian tubes, and force a quantity of air into the 
ears. A better method is that used by the ear specialist. 
It consists in the inflation of the ears by means of a strong 
rubber bag made for the purpose (Fig. 9). The air is 
blown into the nose as the patient is swallowing water or 
speaking the word hook, or some other word ending in k. 




TIG. 9. — POLITZER'S BAG FOR INFLATING THE EARS. 

In a few cases, the specialist finds it necessary to employ 
a tube called a Eustachian catheter (Fig. 10), which is 
passed into the nose and carried back to the opening of 



no 



Tenth Lecture. 



the Eustachian tube. By means of the bag, air is made to 
enter the silver tube, and is forced into the ear. The long 




FIG. IO. — EUSTACHIAN CATHETER. 

rubber tube shown in Fig. n, is an otoscope, with which 
the surgeon is able to hear whether or not, his treatment 
is effective, one end of the tube being placed in his own 
ear, while the other is in the ear of the patient undergo- 
ing treatment. 




FIG. II. — OTOSCOPE. 



The sufferer from catarrh who finds his hearing becom- 
ing impaired, should lose no time in placing himself under 
the care of a thoroughly competent specialist in diseases 
of this sort. 



Earaclie. — A most common accompaniment of nasal 
catarrh, especially in children, is earache. 

Contrary to popular opinion, also, this common affection 
is by no means of little moment, except as it is a source 
of pain and inconvenience. It has happened in more than 
one instance that a neglected earache has resulted in the 
death of the little sufferer after weeks of most acute an- 
guish. In some cases, death results from inflammation of 
the brain at a period many years removed from the first 
attack of the malady, an acute attack being the occasion 
•of inflammation of the delicate membranes of the brain 
which lie in close contact with certain portions of the ear. 



Diseases of the Throat, Etc., Due to Nasal Catarrh. 1 1 1 

It is important that every case of earache, no matter 
how slight, should receive immediate and efficient atten- 
tion, as the pain is often a precursor of deafness, if not of 
something more serious. Space will not allow of a com- 
plete treatment of this subject, but it may be useful to 
the reader to know that the hot-water douche is one of 
the most effective means of relieving pain in the ear aris- 
ing from acute inflammation. The douche can be best ad- 
ministered with a fountain syringe, or its equivalent. In 
the absence of this useful device, the hot water may be 
poured into the ear, the patient placing himself in a reclin- 
ing posture, with the ear in such a position that the wa- 
ter can easily run off. Still another method is to fill the 
ear with warm water, then place in the opening a small 
mass of absorbent cotton, also saturated with water, and 
over this apply fomentations. 

These methods of treatment are vastly superior to the 
old-fashioned onion poultices and similar applications, and 
if thoroughly employed, will not only give great relief 
from pain, but will also prevent a great share of the mis- 
chief which usually results from inflammations of this sort. 

Discharge from the Ear. — A discharge from the 
the ear is usually occasioned by acute inflammation of the 
middle ear, as the result of which the drum membrane is 
ruptured, and the products of suppuration are discharged. 
In cases in which the opening is small, and the suppura- 
tion subsides within a short time, nature often repairs the 
injury to the membrane. In many cases, however, the 
opening remains, and the suppurative process becomes 
chronic. I have often met cases of this kind in which 
there had been a discharge more or less constant for ten 
or fifteen years. It should be understood that a condi- 
tion of this sort is always dangerous, as the bones may 
become affected at any time, and the inflammation may 
thus extend to the coverings of the brain, resulting in 
suppuration and death. 

Treatment. — Carefully cleanse the ear by means of the 



112 Tenth Lecture. 

syphon syringe, employing a solution of carbonate of soda, 
one dram to a pint of water. The water should be as 
warm as can be borne without discomfort, and should en- 
ter the ear with only sufficient force to cause the water 
to flow freely. After the ear has been cleansed in this 
way, it should be carefully dried by means of a bit of ab- 
sorbent cotton wound around the end of a wooden tooth- 
pick, taking care to extend the cotton well beyond the end 
of the tooth-pick, so that the tissues of the ear shall not 
be injured. Finally, fill the canal of the ear with finely 
powdered boracic acid. It will ordinarily hold at least a 
thimbleful of the powder. A small portion should be in- 
troduced at a time, and crowded down to the bottom of 
the canal by the use of the cotton-wrapped tooth-pick. A 
bit of cotton should be placed in the opening of the ear to 
retain the powder. In a few days, or as soon as the pow- 
der becomes softened by the discharge, another ear douche 
should be taken, and a fresh supply of powder introduced. 
I have sometimes succeeded, by the aid of this simple 
remedy, in curing, within a week, cases of chronic dis- 
charge from the ear which had resisted other measures for 
many years. In some cases, the discharge is due to a poly- 
pus in the ear, when it is usually necessary to remove the 
foreign growth, although the method suggested will some- 
times effect a cure without an operation. 



Valuable Prescriptions 

FOR NASAL CATARRH. 



Cleansing Solutions. 

The following solutions are for the purpose of cleansing the 
nasal cavity, preparatory to the application of other medicated 
solutions. They are to be applied with an air atomizer. If nec- 
essary or advisable to employ the anterior or posterior nasal 
douche, or the sponge instead of the atomizer, three times the 
quantity of water indicated in the prescriptions should be added 
to the solution. 



Soda Carbonate, 

Soda Chloride (common salt), 

Water, 


dr. 2. 
dr. 2. 
pt. i. 


Soda Carbonate, 

Borax, 

Water, 




dr. 2. 
dr. 2. 
pt. i. 


Borax, 

Soda Carbonate, 

Glycerine, . 

Water, 




dr. 2. 
dr. 2. 

OZ. I. 

pt. i. 


Cleansing Solution, 
Listerine, 


No. 2, 


8 parts. 
i part. 



JDisinfentcmt Kemeoies. 

The nasal cavity of a person suffering from nasal catarrh is 
unquestionably a peculiarly favorable location for the develop- 
ment of various sorts of microbes, and this is doubtless one of 
the most potent causes of the very obstinate nature of this dis- 
ease. This renders important the application of germicides- 
These solutions should be used freely, after the application of 
other medicated preparations to the nasal cavity, especially in 
cases in which the breath has an unpleasant odor. 

5 Potass. Permanganate, grs. 16. 

Water, pt. i. 

Use with atomizer, or a id three parts of water, and use with 
sponge. 

(H3) H. 



H4 Valuable Prescriptions 



6 Borax, 


dr. i. 


Sodium Chloride, 


dr. i. 


Soda Carbonate, 


dr. 2. 


Glycerine, 


OZ. 2. 


Carbolic Acid, 


dr. i. 


Water, 


pt. i. 


Use with atomizer. 




7 Borax, 


dr. 2. 


Salicylate of Soda, 


dr. 2. 


Glycerine, 


OZ. 2. 


Water, 


oz. 8. 


Use with atomizer. 




8 Soda Carbonate, 


dr. 2. 


Borax, 


dr. 2. 


Liquor Chlorinated Soda, 


dr. 2. 


Glycerine, 


OZ. I. 


Water, 


pt. i. 


Use with air atomizer. 





9 Turpentine, 

Spirits of Camphor, 

Tinct. Benzoin, compound, equal parts. 

Use with the steam inhaler, exhaling through the nose, or place 
on cotton wool, and inhale through a glass tube. 

10 Listerine, 
Water, 

Use with atomizer. 

11 Oil Eucalyptus, 
Oil Wintergreen, 
Menthol Crystals, 
Tinct. Benzoin, comp. 
Boro-Glyceride, 
Aquae, 

Filter through magnesia. This may be 
for the preceding, with equally good effect. 

12 Oil Eucalyptus, 
Oil Petrolina, 

Use with atomizer. 

13 Oil Cubebs, 
Oil Petrolina, 

Use with atomizer. 



oz. 


1. 


oz 


7- 


dr. 
dr. 
dr. 
dr. 
oz. 


i. 
1. 

3- 
1. 


pt. 


1. 


;d 


as a su 


drops 30. 
oz. 4. 


drops 30. 
oz. 4. 



For Nasal Catarrh, 115 

14 Oil Sandal-wood, drops 30. 
Oil Petrolina, oz. 4. 

Use with atomizer. 

15 Oil Scotch Pine, drops 30. 
Oil Petrolina, oz. 4. 

Use with atomizer. 

16 Iodoform, dr. 1. 
Starch, oz. 1. 

A very disagreeable remedy, and to be used only in bad cases 
of offensive breath. Use as a snuff, or introduce by means of a 
blow-tube. 

17 Iodoform, dr. 1. 
Ether, oz. 1. 

Use with an atomizer in same cases as the above. 

Astringent UemeMes. 

The following prescriptions are for use in cases of chronic ca- 
tarrh attended by thickening of the mucous membrane, with pro- 
fuse secretion. 

18 Tannic Acid, dr. 1. 
Water, oz. 4. . . 

To be used with air atomizer, for the nose ; with steam atom- 
izer, for throat or larynx, diluting in cases in which violent cough- 
ing is induced. 

19 Fluid Extract Hydrastis, , 
Water, 

Use same as preceding. 

20 Distilled Extract of Witch-hazel, 
Glycerine, 
Water, 

Use same as preceding. 

21 Zinc Sulphate, 
Water, 

Use same as preceding. 

22 Potass. Alum, 
Water, 

Use same as preceding. 

23 Ferric Alum, 
Water, 

Use with atomizer, same as preceding. 



dr. 


2. 


oz. 


4- 


oz. 


2. 


oz. 


1. 


oz. 


3- 


dr. 


1. 


pt. 


1. 


dr. 


1. 


pt. 


1. 


dr. 


1. 


pt. 


1. 



n6 Valuable Prescriptions 



24 Alum, 

Listerine, 
Water, 




dr. 
oz. 
oz. 


2. 
2. 
IO. 


Use with atomizer. 








Jttiscellaneous. 






25 Boracic acid, 
Starch, 




dr. 
oz. 


2. 
I. 


Use as a snuff two or three times a day. 






2G Menthol, 

Soda Chloride, 
Boracic Acid, 
Soda Carbonate, 




dr. 
dr. 
dr. 
dr. 


I. 
I. 


Use as a snuff, or blow into the 


nostrils several times a day 


27 Boracic Acid, finely powdered, 
Spirits Camphor, 
Starch, 


dr. 
dr. 
oz. 


I. 

2. 
I. 


Use same as preceding. 








28 Tinct. Benzoin, 
Spirits Camphor, 
Cocaine Muriate, 
Starch, 




dr. 
dr. 

gr- 
oz. 


2. 
I. 
20. 
I. 


Use as a snuff. 









29 Alum, desiccated, dr. i. 

Starch, ' dr. 6. 

Use the snuff two or three times daily, after thoroughly cleans- 
ing the nasal cavity. 



30 Gallic, or Tannic Acid, 
Starch, 


dr. 2. 

OZ. I. 


Use same as preceding. 




31 Powdered Sanguinaria, 
Starch, 


dr. i. 
dr. io. 


' Use as a snuff. 




32 Zinc Oxide, 
Starch, 


dr. i. 
dr. 6. 


Use same as preceding. 




33 Sub-Nitrate of Bismuth, 
Starch, 


dr. 4. 

oz. 1, 


Use same as preceding. 





For Nasal Catarrh. wj 



34 Cocaine Muriate, 
Boracic Acid, 
Water, 


gr. io. 

gr.. 5- 

OZ. I. 


Use with air atomizer. May be applied to the throat with a 
swab. 


35 Cocaine Muriate, 

Sub-Carbonate of Bismuth, 


gr. io. 
dr. 4. 


Use as a snuff, every two or three hours. 




36 Cocaine Muriate, 
Hydrastin, 
Cacao Butter, 


gr- 4- 
gr. 8. ' 
dr. 2. 



Make into eight pencils, each about the size of a small lead- 
pencil ; introduce one into one or both nostrils at night. 

37 Zinc Iodide, « dr. 2. 
Listerine, oz. 2. 
Water, oz. 10. 

Especially useful in cases of post-nasal catarrh, accompanied 
by dropping of secretion in the throat. 

Uemebiee to be ^pplted Io tlje ®l)roat. 

The following are a few of the many prescriptions which we 
have used in cases of acute and chronic diseases of the throat, 
and which have proved to be of great service. 

38 Ferric Alum, 
Glycerine, 

Apply with a swab, two or three times daily. 

39 Tannin, 
Glycerine, 

Use same as preceding. 

40 Fluid Extract Hydrastis, 
Glycerine, 

Use same as preceding. 

41 Tinct. Iodine, 
Chloral, 
Glycerine, 

Use same as preceding. 

42 Nitrate of Silver, 
Water, 

Bottle must be kept wrapped with blue or black paper. 



dr. 


I. 


oz. 


1. 


dr. 


I. 


oz. 


I. 


dr. 


2. 


oz. 


I. 


dr. 


I. 


dr. 


I. 


oz. 


2. 


gr. 


4- 


oz. 


2. 



u8 Valuable Prescriptions 

43 Tincture Benzoin, comp., dr. i. 
Water, oz. i. 

Place in inner cup of steam inhaler ; inhale for ten minutes, 
three or four times daily. Excellent in cases of chronic catarrhal 
cough. 

44 Balsam Peru, dr. i. 
Water, oz. i. 

Use same as preceding. 

45 Turpentine, dr. 4. 
Water, oz. 1. 

Ten drops oil of cinnamon or wintergreen may be added to 
the turpentine if more agreeable. Use same as preceding. 

46 Fluid Extract Lupulin, dr. 2. 
Water, oz. 2. 

Use with steam inhaler. 

47 Aqua Ammonia, oz. 1. 
Hydrochloric Acid, oz. 1. 

Do not mix. Place the ammonia in a large, deep bowl. Place 
the hydrochloric acid in a small tea-cup ; set the tea-cup con- 
taining the hydrochloric acid in a bowl containing the ammo- 
nia. White fumes will arise. Gather and inhale these fumes by 
means of a paper cone. The fumes will be given off until the 
strength of the ammonia is exhausted. By this arrangement, the 
air of a sleeping-room or living-room may be kept continually 
charged with the fumes of chloride of ammonia. 

48 



Oil Cubebs, 


dr. 1. 


Oil Sandal-wood, 


dr. 1, 


Oil Scotch Pine, 


dr. 1, 


Oil Eucalyptus, 


dr. 1 


Tinct. Benzoin, compound, 


dr. 4, 



Place in a bottle containing several dry sponges, and arranged 
with rubber cork and glass tubes, as shown in Fig. 6. Use sev- 
eral times daily, drawing the air through the bent tube, and ex-, 
haling through the nose. By connecting an atomizer bulb with 
the straight tube, the air charged with balsam from the bottle, 
may be forced into the nostrils with good effect. 

49 Tinct. of Benzoin, compound, dr. 4. 

Balsam Peru, dr. 2. 

Oil Eucalyptus, dr. 1. 

Oil Cubebs, dr. 1. 

Alcohol, oz. 2. 
Put the mixture in a tea-cup, and place this in a basin of wa- 
ter, which should be kept simmering over a spirit-lamp. This 



oz. 


i. 


oz. 


i. 


dr. 


2. 


dr. 


2. 


dr. 


I. 


dr. 


I. 


dr. 


4- 


oz. 


2. 



T^r Nasal Catarrh. 119 

will charge the air of a bed-room with balsamic odors, which are 
purifying and wholesome, and to some degree advantageous in 
diseases of the air-passages. 

50 Tinct. of Benzoin, compound, 
Tinct. Tulu, 
Oil Sandal-wood, 
Oil Scotch Pine, 
Oil Eucalyptus, 
Turpentine, 
Menthol, 
Alcohol, 

Make a thick pad of cotton wool, cover with cheese-cloth, and 
quilt loosely. Saturate this with the above mixture. Allow the 
alcohol to evaporate, cover with flannel, and place inside the pil- 
low at night. 

51 Soda Bi-carbonate, dr. 1. 
Aquae, oz. 4. 

Use with air atomizer, hot as can be borne, in cases of coryza, 
<5r acute cold. 

52 

Place a dram of menthol crystals in a glass tube, with a little 
absorbent cotton in each end, to retain the crystals. This con- 
stitutes a menthol inhaler. A clay pipe may be used. 

53 Potass. Bromide, dr. 2. 
Soda Carbonate, dr. 2. 
Aquae, pt. 1. 

Use hot, with an air atomizer, in cases of acute catarrh, every 
four to six hours. 

54 Papayotin, gr. 75. 
Distilled Water, dr. 1%. 
Glycerine, dr. 4. 

Apply to diphtheritic membrane with a camel' s-hair brush. 



EYE LOTIONS. 

The following lotions will be found of service in appropriate 
cases ; but it should always be remembered that the eye is a del- 
icate organ, and that it is far better to employ the services of a 
good specialist in diseases of the eye, than for one to try to treat 
even apparently simple maladies of this organ. 

55 Zinc Sulphate, gr. 2. 

Water, oz. 2. 



120 Valuable Prescriptions 

Apply a few drops, two or three times a day, with a dropper or 
bit of absorbent cotton twisted into a roll. 



56 Nitrate of Silver, 
Water, 


gr. 2. 

OZ. 2. 


Apply same as preceding. 




57 Cocaine Muriate, 
Boracic Acid, 
Water, 


gr. 20. 
gr. 5- 

OZ. I. 


Apply same as preceding. 




58 Zinc Sulphate, 

Morphia Sulphate, 
Water, 


gr. 2. 
gr. 2. 

OZ. 2. 


Apply same as preceding. 




59 Boracic Acid, 
Water, 


gr- 5- 

OZ. 2. 


Apply same as preceding. 




60 Acetate of Lead, 
Water, 


gr. io. 
oz. 8. 


Moisten a cloth with this solution, 


and lay upon the eyes on 


retiring at night. 








REMEDIES TO BE TAKEN INTERNALLY 
FOR COUGH. 

61 Soda Brom., dr. 2. 
Syrup of Licorice, oz. 2. 

Take a teaspoonful in a glass of hot water every four hours to 
relieve a dry, harsh cough. 

62 Lemon juice, 
Honey, 
Glycerine, 

A teaspoonful every two or three hours. 

63 Fl. Ex. Pinus Candensis, 
Syr. Ipecac, 
Syr. Tolu, oz. 4. 

Take a teaspoonful three or four times a day. 



oz. 


2. 


oz. 


2. 


oz. 


1. 


dr. 
dr. 


4- 



m 



((lt((C(<((ti(W 



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